Determinants and clinical outcome of uptitration of ACE-inhibitor and beta-blocker in patients with heart failure: a prospective European study

Ouwerkerk, W. et al. (2017) Determinants and clinical outcome of uptitration of ACE-inhibitor and beta-blocker in patients with heart failure: a prospective European study. European Heart Journal, 38(24), pp. 1883-1890. (doi: 10.1093/eurheartj/ehx026) (PMID:28329163)

Abstract

Introduction: Despite clear guidelines recommendations, most patients with heart failure and reduced ejection–fraction (HFrEF) do not attain guideline-recommended target doses. We aimed to investigate characteristics and for treatment-indication-bias corrected clinical outcome of patients with HFrEF that did not reach recommended treatment doses of ACE-inhibitors/Angiotensin receptor blockers (ARBs) and/or beta-blockers. Methods and results: BIOSTAT-CHF was specifically designed to study uptitration of ACE-inhibitors/ARBs and/or beta-blockers in 2516 heart failure patients from 69 centres in 11 European countries who were selected if they were suboptimally treated while initiation or uptitration was anticipated and encouraged. Patients who died during the uptitration period (n = 151) and patients with a LVEF > 40% (n = 242) were excluded. Median follow up was 21 months. We studied 2100 HFrEF patients (76% male; mean age 68 ±12), of which 22% achieved the recommended treatment dose for ACE-inhibitor/ARB and 12% of beta-blocker. There were marked differences between European countries. Reaching <50% of the recommended ACE-inhibitor/ARB and beta-blocker dose was associated with an increased risk of death and/or heart failure hospitalization. Patients reaching 50–99% of the recommended ACE-inhibitor/ARB and/or beta-blocker dose had comparable risk of death and/or heart failure hospitalization to those reaching ≥100%. Patients not reaching recommended dose because of symptoms, side effects and non-cardiac organ dysfunction had the highest mortality rate (for ACE-inhibitor/ARB: HR 1.72; 95% CI 1.43–2.01; for beta-blocker: HR 1.70; 95% CI 1.36–2.05). Conclusion: Patients with HFrEF who were treated with less than 50% of recommended dose of ACE-inhibitors/ARBs and beta-blockers seemed to have a greater risk of death and/or heart failure hospitalization compared with patients reaching ≥100%.

• Item Type: Articles
• Additional Information: This work was supported by a grant from the European Commission [FP7-242209-BIOSTAT-CHF; EudraCT 2010-020808-29]
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Cleland, Professor John
• Authors: Ouwerkerk, W., Voors, A.A., Anker, S.D., Cleland, J.G., Dickstein, K., Filippatos, G., van der Harst, P., Hillege, H.L., Lang, C.C., ter Maaten, J.M., Ng, L.L., Ponikowski, P., Samani, N.J., van Veldhuisen, D.J., Zannad, F., Metra, M., and Zwinderman, A.H.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre
• Journal Name: European Heart Journal
• Publisher: Oxford University Press
• ISSN: 0195-668X
• ISSN (Online): 1522-9645
• Published Online: 11 March 2017
• Copyright Holders: Copyright © 2017 The Authors
• First Published: First published in European Heart Journal 38(24): 1883-1890
• Publisher Policy: Reproduced in accordance with the publisher copyright policy