Author + information
- Tarek Ajam,
- Samer Ajam,
- Srikant Devaraj,
- Stephen Sawada and
- Masoor Kamalesh
Background: The relative importance of dose of beta blocker used versus decrease in average heart rate achieved on survival remains unclear. We aimed to compare the effect of beta blocker dose and heart rate on mortality in patients with heart failure due to systolic dysfunction.
Methods: We queried the VA's databases to identify all patients with heart failure from 2007 to 2015. 36,174 patients were compared using low dose beta blocker [carvedilol or metoprolol] matched to as many patients using high dose beta blocker. Using Cox proportional hazard model on the matched sample, adjusting for patient characteristics, we assessed the impact of beta blocker dose (metoprolol and carvedilol) on overall mortality of heart failure patients.
Results: Beta blocker dose was related to mortality. After dividing average heart rate into separate quartiles and adjusting for it and patient characteristics, we found that the high dose of beta blocker was associated with lower overall mortality as compared to low dose of beta blocker (HR: 0.7429, 95% CI: 0.7250-0.7612, p<0.0001) independent of the heart rate achieved. The results held for all four quartiles of average heart rate.
Conclusions: Higher dose of beta blocker therapy was associated with a greater reduction in mortality in heart failure patients. This was independent of the extent of achieved heart rate lowering effect of beta blockers. Thus, in heart failure patients, the dose of beta blocker may be more important than a lower achieved heart rate to improve mortality.
Room 144 A
Saturday, March 18, 2017, 8:25 a.m.-8:35 a.m.
Session Title: Highlighted Original Research: Heart Failure and Cardiomyopathies and the Year in Review
Abstract Category: 14. Heart Failure and Cardiomyopathies: Therapy
Presentation Number: 902-06
- 2017 American College of Cardiology Foundation