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Prognostic role of β-blocker selectivity and dosage regimens in heart failure patients. Insights from the MECKI score database

By Stefania Paolillo, Massimo Mapelli, Alice Bonomi, Ugo Corrà, Massimo Piepoli, Fabrizio Veglia, Elisabetta Salvioni, Piero Gentile, Rocco Lagioia, Marco Metra, Giuseppe Limongelli, Gianfranco Sinagra, Gaia Cattadori, Angela B. Scardovi, Valentina Carubelli, Domenico Scrutino, Roberto Badagliacca, Rosa Raimondo, Michele Emdin, Damiano Magrì, Michele Correale, Gianfranco Parati, Sergio Caravita, Emanuele Spadafora, Federica Re, Mariantonietta Cicoira, Maria Frigerio, Maurizio Bussotti, Chiara Minà, Fabrizio Oliva, Elisa Battaia, Romualdo Belardinelli, Alessandro Mezzani, Luigi Pastormerlo, Andrea Di Lenarda, Claudio Passino, Susanna Sciomer, Annamaria Iorio, Elena Zambon, Marco Guazzi, Giuseppe Pacileo, Roberto Ricci, Mauro Contini, Anna Apostolo, Pietro Palermo, Francesco Clemenza, Giovanni Marchese, Simone Binno, Carlo Lombardi, Andrea Passantino, Pasquale Perrone Filardi and Piergiuseppe Agostoni


AIMS:\ud The use of β-blockers represents a milestone in the treatment of heart failure with reduced ejection fraction (HFrEF). Few studies have compared β-blockers in HFrEF, and there is little data on the effects of different doses. The present study aimed to investigate in a large database of HFrEF patients (MECKI score database) the association of β-blocker treatment with a composite outcome of cardiovascular death, urgent heart transplantation or left ventricular assist device implantation, addressing the role of β-selectivity and dosage regimens.\ud METHODS AND RESULTS:\ud In 5242 HFrEF patients, we investigated the role of: (i) β-blocker treatment vs. non-β-blocker treatment, (ii) β1-/β2-receptor-blockers vs. β1-selective blockers, and (iii) daily β-blocker dose. Patients were followed for 3.58 years, and 1101 events (18.3%) were observed; 4435 patients (86.8%) were on β-blockers, while 807 (13.2%) were not. At 5 years, β-blocker-patients showed a better outcome than non-β-blocker-subjects [hazard ratio (HR) 0.48, P < 0.0001], while also considering potential confounders. A comparable prognosis was observed at 5 years in the β1-/β2-receptor-blocker (n = 2219) vs. β1-selective group (n = 2216) (HR 0.95, P = ns). A better prognosis was observed in high-dose (>2 5 mg carvedilol equivalent daily dose, n = 1005) patients than in both medium dose (12.5-25 mg, n = 1431) and low dose (<12.5 mg, n = 1960) (HR 1.97, P < 0.001; HR 1.95, P = 0.001, respectively), with no differences between the last two groups (HR 0.84, P = ns).\ud CONCLUSION:\ud In a large population of chronic HFrEF patients, β-blockers were associated with a more favourable prognosis without any difference between β1- and β2-receptor-blockers vs. β1-selective blockers. A better outcome was observed in subjects receiving a high daily dose

Topics: Equivalent dose, Heart failure, Prognosis, β-Blocker selectivity, β-Blockers, Cardiology and Cardiovascular Medicine
Year: 2017
DOI identifier: 10.1002/ejhf.775
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