Utilisation and optimisation of beta-adrenergic receptor blockers over a 6-month period among chronic heart failure patients with reduced ejection fraction
DOI:
https://doi.org/10.7196/SAMJ.2023.v113i9.784Keywords:
heart failure, Beta-blockers Utilization and Optimization.Abstract
Background. Beta-adrenergic receptor blocker (BARB) drugs are a wide range of medicines that are used in various conditions, including chronic heart failure (HF). Several studies have reported a wide-ranging inappropriate use of evidence-based beta-blockers (EBBBs) in chronic HF in both inpatients and outpatients.
Objectives. To assess the utilisation and optimisation of EBBBs among patients with HF who presented with a reduced ejection fraction (HFrEF).
Methods. A hospital-based retrospective cross-sectional study was carried out at the Adult University Teaching Hospital (AUTH), in Lusaka, Zambia, where patient medical files for the period of 1 July 2018 to 31 July 2021 were reviewed. Patient information, including file number, age, sex, type of BARB and the dose used, was recorded on the developed and validated checklist. Multivariable regression analysis was performed to identify factors associated with utilisation of BARBs.
Results. Of the 173 medical records reviewed, BARBs were utilised in 101 (58.4%) patients. Among the patients who utilised BARBs, 96 (95.0%) were taking EBBBs, while the rest (n=5, 5.0 %) were taking atenolol, which is a non-EBBB. Among the patients who were on EBBBs, none of them received the optimal dose. Age ≥65 years (adjusted odds ratio (aOR) 0.3, 95% confidence interval (CI) 0.17 - 0.64), previous hospitalisation (aOR 0.3, 95% CI 0.13 - 0.51) and furosemide dose ≥40 mg (aOR 0.4, 95% CI 0.21 - 0.64) were significantly associated with lower likelihood of BARB utilisation. New York Heart Association (NYHA) class II (aOR 3.4, 95% CI 1.08 - 10.7), NYHA class III (aOR 4.8, 95% CI 1.65 - 13.7) and patients using at least 5 medications (aOR 5.0, 95% CI 2.91 - 8.77) were independent predictors of BARB utilisation.
Conclusion. This study showed that 95.0% of chronic HF patients were utilising EBBBs, and none received the optimal dose as recommended in the guidelines. Pharmacotherapy with EBBBs should be optimised among patients with chronic HfrEF, as these drugs reduce both morbidity and mortality.
References
Savarese G, Lund LH. Global public health burden of heart failure. Cardiac Failure Rev 2017;3(1):7.
https://doi.org/10.15420/cfr.2016:25:2
Benjamin EJ, Virani SS, Callaway CW, et al. Heart disease and stroke statistics – 2018 update: A report from the American Heart Association. Circulation 2018;137(12):e67-e492. https://doi.org/10.1161/ CIR.0000000000000558
Agbor VN, Essouma M, Ntusi NA, Nyaga UF, Bigna JJ, Noubiap JJ. Heart failure in sub-Saharan Africa: A contemporaneous systematic review and meta-analysis. Int J Cardiol 2018;257:207-215. https://doi. org/10.1016/j.ijcard.2017.12.048
Nyaga UF, Bigna JJ, Agbor VN, Essouma M, Ntusi NA, Noubiap JJ. Data on the epidemiology of heart failure in sub-Saharan Africa. Data Brief 2018;17:1218-1239. https://doi.org/10.1016/j.dib.2018.01.100 5. Komajda M, Boehm M, Borer JS, et al. Incremental benefit of drug therapies for chronic heart failure with reduced ejection fraction: A network meta‐analysis. Euro J Heart Failure 2018;20(9):1315-1322. https://doi.org/10.1002/ejhf.1234
Wieser M, Rhyner D, Martinelli M, et al. Pharmacological therapy of heart failure with reduced ejection fraction. Therapeutische Umschau 2018;75(3):180-186. https://doi.org/10.1024/0040-5930/a000986
Chang H-Y, Wang C-C, Wei J, et al. Gap between guidelines and clinical practice in heart failure with reduced ejection fraction: Results from TSOC-HFrEF registry. J Chinese Med Assoc 2017;80(12):750- 757. https://doi.org/10.1016/j.jcma.2017.04.011
Wang J, Gareri C, Rockman HA. G-protein–coupled receptors in heart disease. Circulation Res 2018;123(6):716-735. https://doi.org/10.1161/CIRCRESAHA.118.311403
Capote LA, Perez RM, Lymperopoulos A. GPCR signaling and cardiac function. Euro J Pharma 2015;763:143-148. https://doi.org/10.1016/j.ejphar.2015.05.019
Packer M, Fowler MB, Roecker EB, et al. Effect of carvedilol on the morbidity of patients with severe chronic heart failure: Results of the carvedilol prospective randomized cumulative survival (COPERNICUS) study. Circulation 2002;106(17):2194-2199. https://doi.org/10.1161/01. CIR.0000035653.72855.BF
Yancy CW, Jessup M, Bozkurt B, et al. 2017 ACC/AHA/HFSA focused update of the 2013 ACCF/ AHA guideline for the management of heart failure: A report of the American College of Cardiology/ American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. J Am Coll Cardiol 2017;70(6):776-803. https://doi.org/10.1016/j.jacc.2013.05.019
Domanski MJ, Krause-Steinrauf H, Massie BM, et al. A comparative analysis of the results from 4 trials of β-blocker therapy for heart failure: BEST, CIBIS-II, MERIT-HF, and COPERNICUS. J Cardiac Failure 2003;9(5):354-363. https://doi.org/10.1054/S1071-9164(03)00133-7
Investigators C-I. The cardiac insufficiency bisoprolol study II (CIBIS-II): A randomised trial. Lancet 1999;353(9146):9-13. https://doi.org/10.1016/S0140-6736(98)11181-9
MERIT-HF Study Group. Effect of metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL randomised intervention trial in congestive heart failure (MERIT-HF). Lancet 1999;353(9169):2001- 2007. https://doi.org/10.1016/S0140-6736(99)04440-2
Loop MS, van Dyke MK, Chen L, et al. Low utilisation of beta-blockers among medicare beneficiaries hospitalized for heart failure with reduced ejection fraction. J Cardiac Failure 2019;25(5):343-351. https://doi.org/10.1016/j.cardfail.2018.10.005
Berthelot E, Eicher J, Salvat M, Seronde M, de Groote P. Medical inertia in the optimisation of heart failure treatment after discharge and its relationship to outcome. Health Care Current Rev 2018;6(1):6. https://doi.org/10.4172/2375-4273.1000221
Krum H, Hill J, Fruhwald F, et al. Tolerability of beta‐blockers in elderly patients with chronic heart failure: The COLA II study. Eur J Heart Failure 2006;8(3):302-307. https://doi.org/10.1016/j. ejheart.2005.08.002
Niriayo YL, Asgedom SW, Demoz GT, Gidey K. Treatment optimisation of beta-blockers in chronic heart failure therapy. Sci Rep 2020;10(1):1-8. https://doi.org/10.1038/s41598-020-72836-4
Eriksen-Volnes T, Westheim A, Gullestad L, Slind EK, Grundtvig M. β-blocker doses and heart rate in patients with heart failure: Results from the National Norwegian Heart Failure Registry. Biomed Hub 2020;5(1):1-10. https://doi.org/10.1159/000505474
Barywani SB, Ergatoudes C, Schaufelberger M, Petzold M, Fu ML. Does the target dose of neurohormonal blockade matter for outcome in systolic heart failure in octogenarians? Int J Cardiol 2015;187:666-672. https://doi.org/10.1016/j.ijcard.2015.03.428
Kiel RG, Deedwania P. The safety and tolerability of beta blockers in heart failure with reduced ejection fraction: Is the current underutilisation of this evidence-based therapy justified? Exp Op Drug Safety 2015;14(12):1855-1863. https://doi.org/10.1517/14740338.2015.1102225
Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Kardiologia Polska 2016;74(10):1037-1147. http://doi.org:10.1093/ eurheartj/ehw128
McCullough PA, Philbin EF, Spertus JA, Sandberg KR, Kaatz S. Angiotensin-converting enzyme inhibitors and beta-blockers in African Americans with heart failure. Ethn Dis 2003;13(3):331-336. 24. Szymanski P, Badri M, Mayosi B. Clinical characteristics and causes of heart failure, adherence to
treatment guidelines, and mortality of patients with acute heart failure: Experience at Groote Schuur Hospital, Cape Town, South Africa. S Afr Med J 2018;108(2):94-98. https://doi.org/10.7196/ SAMJ.2018.v108i2.12519
Anane C. The impact of the β-blocker, carvedilol, in the treatment of heart failure patients in a teaching hospital in Ghana. Int J Cardiol 2010;3(14):13.
Kramer JM, Curtis LH, Dupree CS, et al. Comparative effectiveness of β-blockers in elderly patients with heart failure. Arch Intern Med 2008;168(22):2422-2428. http://doi.org:10.1001/ archinternmed.2008.511
Fowler MB, Vera-Llonch M, Oster G, et al. Influence of carvedilol on hospitalisations in heart failure: Incidence, resource utilisation and costs. J Am Coll Cardiol 2001;37(6):1692-1699. https://doi. org/10.1016/S0735-1097(01)01190-1
Gupta R, Tang WW, Young JB. Patterns of β-blocker utilisation in patients with chronic heart failure: Experience from a specialized outpatient heart failure clinic. Am Heart J 2004;147(1):79-83. https:// doi.org/10.1016/j.ahj.2003.07.022
Greene SJ, Butler J, Albert NM, et al. Medical therapy for heart failure with reduced ejection fraction: The CHAMP-HF registry. J Am Coll Cardiol 2018;72(4):351-366. https://doi.org/10.1016/j. jacc.2018.04.070
Brunner-La Rocca H-P, Linssen GC, Smeele FJ, et al. Contemporary drug treatment of chronic heart failure with reduced ejection fraction: The CHECK-HF registry. JACC Heart Failure 2019;7(1):13-21. https://doi.org/10.1016/j.jchf.2018.10.010
Atallah B, Sadik ZG, Osoble AA, et al. Establishing the first pharmacist‐led heart failure medication optimisation clinic in the Middle East Gulf Region. J Am Coll Clin Pharm 2020;3(5):877-884. https:// doi.org/10.1002/jac5.1219
Downloads
Published
Issue
Section
License
Copyright (c) 2023 M Kampamba, P Mweetwa, W Mufwambi, A Hamachila, J Hangoma
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Licensing Information
The SAMJ is published under an Attribution-Non Commercial International Creative Commons Attribution (CC-BY-NC 4.0) License. Under this license, authors agree to make articles available to users, without permission or fees, for any lawful, non-commercial purpose. Users may read, copy, or re-use published content as long as the author and original place of publication are properly cited.
Exceptions to this license model is allowed for UKRI and research funded by organisations requiring that research be published open-access without embargo, under a CC-BY licence. As per the journals archiving policy, authors are permitted to self-archive the author-accepted manuscript (AAM) in a repository.
Publishing Rights
Authors grant the Publisher the exclusive right to publish, display, reproduce and/or distribute the Work in print and electronic format and in any medium known or hereafter developed, including for commercial use. The Author also agrees that the Publisher may retain in print or electronic format more than one copy of the Work for the purpose of preservation, security and back-up.
