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Beta-blocker dosing in community-based treatment of heart failure.
- Source :
-
American heart journal [Am Heart J] 2007 Jun; Vol. 153 (6), pp. 1029-36. - Publication Year :
- 2007
-
Abstract
- Background: Community patients with heart failure (HF) are older, less often treated by HF specialists, and have more comorbidity than those in randomized clinical trials. These differences might affect beta-blocker prescribing in HF.<br />Methods: To explore patterns of beta-blocker prescribing for HF in the community and their association with outcomes, we determined carvedilol doses at end titration in 4113 patients from a community-based beta-blocker HF registry according to physician and patient characteristics, HF severity, and rates of hospitalization and death.<br />Results: Female sex, age > or = 65 years, and left ventricular ejection fraction > or = 35% were associated with lower beta-blocker doses. Average daily dose of beta-blocker was lower with worse baseline New York Heart Association class. More patients of cardiologists achieved carvedilol doses > or = 25 mg twice daily, whereas in those of noncardiologists lower doses were more common. Relative risk of HF hospitalizations or all-cause death was significantly lower with higher doses of beta-blocker.<br />Conclusions: Beta-blocker dosing in community HF appears lower than in randomized clinical trials, especially when prescribed by noncardiologists. At all doses, patients taking the beta-blocker carvedilol have a lower incidence of death and HF hospitalization than those discontinuing it, regardless of physician type in the community setting.
- Subjects :
- Aged
Carvedilol
Community Networks statistics & numerical data
Drug Administration Schedule
Drug Prescriptions statistics & numerical data
Female
Heart Failure classification
Heart Failure mortality
Humans
Length of Stay statistics & numerical data
Male
Middle Aged
Severity of Illness Index
Survival Rate
United States
Adrenergic beta-Antagonists administration & dosage
Carbazoles administration & dosage
Heart Failure drug therapy
Propanolamines administration & dosage
Subjects
Details
- Language :
- English
- ISSN :
- 1097-6744
- Volume :
- 153
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- American heart journal
- Publication Type :
- Academic Journal
- Accession number :
- 17540206
- Full Text :
- https://doi.org/10.1016/j.ahj.2007.03.010