Details

Autor(en) / Beteiligte

• Campodonico, Jeness
• Piepoli, Massimo
• Clemenza, Francesco
• Bonomi, Alice
• Paolillo, Stefania
• Salvioni, Elisabetta
• Corrà, Ugo
• Binno, Simone
• Veglia, Fabrizio
• Lagioia, Rocco
• Sinagra, Gianfranco
• Cattadori, Gaia
• Scardovi, Angela B.
• Metra, Marco
• Senni, Michele
• Scrutinio, Domenico
• Raimondo, Rosa
• Emdin, Michele
• Magrì, Damiano
• Parati, Gianfranco
• Re, Federica
• Cicoira, Mariantonietta
• Minà, Chiara
• Limongelli, Giuseppe
• Correale, Michele
• Frigerio, Maria
• Bussotti, Maurizio
• Perna, Enrico
• Battaia, Elisa
• Guazzi, Marco
• Badagliacca, Roberto
• Di Lenarda, Andrea
• Maggioni, Aldo
• Passino, Claudio
• Sciomer, Susanna
• Pacileo, Giuseppe
• Mapelli, Massimo
• Vignati, Carlo
• Lombardi, Carlo
• Filardi, Pasquale Perrone
• Agostoni, Piergiuseppe

Titel

Dose-dependent efficacy of β-blocker in patients with chronic heart failure and atrial fibrillation

Ist Teil von

• International journal of cardiology, 2018-12, Vol.273, p.141-146

Ort / Verlag

Netherlands: Elsevier B.V

Erscheinungsjahr

2018

Quelle

MEDLINE

Beschreibungen/Notizen

• The usefulness of β-blockers in heart failure (HF) patients with permanent atrial fibrillation (AF) has been questioned. We analyzed data from HF patients (958 patients (801 males, 84%, age 67 ± 11 years)) with AF enrolled in the MECKI score database. We evaluated prognosis (composite of cardiovascular death, urgent heart transplant, or left ventricular assist device) of patients receiving β-blockers (n = 777, 81%) vs. those not treated with β-blockers (n = 181, 19%). We also analyzed the role β1-selectivity and the role of daily β-blocker dose. To account for different HF severity, Kaplan-Meier survival curves were normalized for relevant confounding factors and for treatment strategies. Dose was available in 629 patients. Median follow-up was 1312 (577–2304) days in the entire population, 1203 (614–2420) and 1325 (569–2300) days in patients not receiving and receiving β-blockers. 224 (23%, 54/1000 events/year), 163 (21%, 79/1000 events/year), and 61 (34%, 49/1000 events/year) events were recorded, respectively. At 10-year patients treated with β-blockers had a better outcome (HR 0.447, p < 0.01) with no effects as regards β1selective drugs (53%) vs. β1-β2 blockers (47%). Survival improved in parallel with β-blocker dose increase (HR 0.296, 0.496, 0.490 for the high, medium, and low dose vs. no β-blockers, p < 0.0001). HF patients with AF taking a β-blocker have a better outcome (with a survival improvement in parallel with daily dose but no differences as regards β1 selectivity) but this does not mean that β-blockers improve outcomes in these patients as we cannot control for all the potential confounders associated with β-blocker use. •Usefulness of β-blockers in patients with atrial fibrillation and heart failure•No impact of β1 selectivity on prognosis in heart failure patients with AF•Importance of daily β-blocker dose on long-term outcomes of patients with AF and HF