Trend of Clinical Outcome and Surrogate Markers During Titration of β-Blocker in Heart Failure Patients With Reduced Ejection Fraction – Relevance of Achieved Heart Rate and β-Blocker Dose –

Naoko Kato; Koichiro Kinugawa; Teruhiko Imamura; Hironori Muraoka; Shun Minatsuki; Toshiro Inaba; Hisataka Maki; Taro Shiga; Masaru Hatano; Atsushi Yao; Issei Komuro; Ryozo Nagai

doi:10.1253/circj.CJ-12-1241

Heart Failure

Trend of Clinical Outcome and Surrogate Markers During Titration of β-Blocker in Heart Failure Patients With Reduced Ejection Fraction

– Relevance of Achieved Heart Rate and β-Blocker Dose –

Naoko Kato, Koichiro Kinugawa, Teruhiko Imamura, Hironori Muraoka, Shun Minatsuki, Toshiro Inaba, Hisataka Maki, Taro Shiga, Masaru Hatano, Atsushi Yao, Issei Komuro, Ryozo Nagai

Author information

Naoko Kato
Department of Cardiovascular Medicine, University of Tokyo Graduate School of Medicine
Koichiro Kinugawa
Department of Therapeutic Strategy for Heart Failure, University of Tokyo Graduate School of Medicine
Teruhiko Imamura
Department of Cardiovascular Medicine, University of Tokyo Graduate School of Medicine
Hironori Muraoka
Department of Cardiovascular Medicine, University of Tokyo Graduate School of Medicine
Shun Minatsuki
Department of Cardiovascular Medicine, University of Tokyo Graduate School of Medicine
Toshiro Inaba
Department of Cardiovascular Medicine, University of Tokyo Graduate School of Medicine
Hisataka Maki
Department of Cardiovascular Medicine, University of Tokyo Graduate School of Medicine
Taro Shiga
Department of Cardiovascular Medicine, University of Tokyo Graduate School of Medicine
Masaru Hatano
Department of Cardiovascular Medicine, University of Tokyo Graduate School of Medicine
Atsushi Yao
Department of Cardiovascular Medicine, University of Tokyo Graduate School of Medicine
Issei Komuro
Department of Cardiovascular Medicine, University of Tokyo Graduate School of Medicine
Ryozo Nagai
Department of Cardiovascular Medicine, University of Tokyo Graduate School of Medicine

Keywords: Beta-blocker, Heart failure, Heart rate, Morbidity, Mortality

JOURNAL FREE ACCESS

2013 Volume 77 Issue 4 Pages 1001-1008

DOI https://doi.org/10.1253/circj.CJ-12-1241

Browse “Advance online publication” version

Details

Abstract

Background: The aim of this study was to examine trends of clinical outcome and to clarify surrogate markers when titrating β-blocker in heart failure patients with reduced left ventricular ejection fraction (HFrEF, LVEF <50%). Methods and Results: Consecutive HFrEF patients starting on β-blocker were divided into 2 groups according to time of dose fixation attainment: before 31 December 2005 (group 1, n=108) or after 1 January 2006 (group 2, n=119). There were no significant differences in patient characteristics between the 2 groups at baseline. Beta-blocker fixed dose was higher with lower resting heart rate in group 2 (6.2±5.7mg/day vs. 9.5±9.1mg/day in carvedilol equivalent dose, P=0.001; 74.2±11.1beats/min vs. 70.2±9.7beats/min, P=0.004). The rate of HF hospitalization and/or all-cause death after 36 months was lower in group 2 than in group 1 (22% vs. 38%, P=0.011; hazard ratio, 0.90; P=0.012). Cox regression analysis showed that β-blocker ≥10mg/day and achieved heart rate ≤71beats/min predicted a better outcome (both P<0.05). Conclusions: Recent improvement of clinical outcome among HFrEF patients may be attributable to the up-titration policy accompanying lowered heart rate. Resting heart rate ≤71beats/min and β-blocker ≥10mg/day (ie, 50% of the target dose for Japanese patients) could be surrogate markers when titrating β-blocker. (Circ J 2013; 77: 1001–1008)

Corresponding author

Register with J-STAGE for free!