Aims: The use of Î²-blockers represents a milestone in the treatment of heart failure with reduced ejection fraction (HFrEF). Few studies have compared Î²-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 Î²-blocker treatment with a composite outcome of cardiovascular death, urgent heart transplantation or left ventricular assist device implantation, addressing the role of Î²-selectivity and dosage regimens. Methods and results: In 5242 HFrEF patients, we investigated the role of: (i) Î²-blocker treatment vs. non-Î²-blocker treatment, (ii) Î²1-/Î²2-receptor-blockers vs. Î²1-selective blockers, and (iii) daily Î²-blocker dose. Patients were followed for 3.58 years, and 1101 events (18.3%) were observed; 4435 patients (86.8%) were on Î²-blockers, while 807 (13.2%) were not. At 5 years, Î²-blocker-patients showed a better outcome than non-Î²-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 Î²1-/Î²2-receptor-blocker (n = 2219) vs. Î²1-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 (12.5â25 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). Conclusion: In a large population of chronic HFrEF patients, Î²-blockers were associated with a more favourable prognosis without any difference between Î²1- and Î²2-receptor-blockers vs. Î²1-selective blockers. A better outcome was observed in subjects receiving a high daily dose.
Paolillo, S., Mapelli, M., Bonomi, A., Corrã , U., Piepoli, M., Veglia, F., et al. (2017). Prognostic role of β-blocker selectivity and dosage regimens in heart failure patients. Insights from the MECKI score database. EUROPEAN JOURNAL OF HEART FAILURE, 19(7), 904-914 [10.1002/ejhf.775].
|Citazione:||Paolillo, S., Mapelli, M., Bonomi, A., Corrã , U., Piepoli, M., Veglia, F., et al. (2017). Prognostic role of β-blocker selectivity and dosage regimens in heart failure patients. Insights from the MECKI score database. EUROPEAN JOURNAL OF HEART FAILURE, 19(7), 904-914 [10.1002/ejhf.775].|
|Tipo:||Articolo in rivista - Articolo scientifico|
|Carattere della pubblicazione:||Scientifica|
|Presenza di un coautore afferente ad Istituzioni straniere:||No|
|Titolo:||Prognostic role of β-blocker selectivity and dosage regimens in heart failure patients. Insights from the MECKI score database|
|Autori:||Paolillo, S; Mapelli, M; Bonomi, A; Corrã , U; Piepoli, M; Veglia, F; Salvioni, E; Gentile, P; Lagioia, R; Metra, M; Limongelli, G; Sinagra, G; Cattadori, G; Scardovi, A; Carubelli, V; Scrutino, D; Badagliacca, R; Raimondo, R; Emdin, M; Magrã¬, D; Correale, M; Parati, G; Caravita, S; Spadafora, E; Re, F; Cicoira, M; Frigerio, M; Bussotti, M; Minã , C; Oliva, F; Battaia, E; Belardinelli, R; Mezzani, A; Pastormerlo, L; Di Lenarda, A; Passino, C; Sciomer, S; Iorio, A; Zambon, E; Guazzi, M; Pacileo, G; Ricci, R; Contini, M; Apostolo, A; Palermo, P; Clemenza, F; Marchese, G; Binno, S; Lombardi, C; Passantino, A; Perrone Filardi, P; Agostoni, P|
|Data di pubblicazione:||2017|
|Rivista:||EUROPEAN JOURNAL OF HEART FAILURE|
|Digital Object Identifier (DOI):||http://dx.doi.org/10.1002/ejhf.775|
|Appare nelle tipologie:||01 - Articolo su rivista|