Relationship of beta-blocker dose with outcomes in ambulatory heart failure patients with systolic dysfunction: results from the HF-ACTION (Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training) trial.
Relationship of beta-blocker dose with outcomes in ambulatory heart failure patients with systolic dysfunction: results from the HF-ACTION (Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training) trial.
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DOI：
10.1016/j.jacc.2012.03.023
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发表时间：
2012-07-17
影响因子：
24
通讯作者：
O'Connor, Christopher M.
中科院分区：
文献类型：
--
作者：
Fiuzat, Mona;Wojdyla, Daniel;Kitzman, Dalane;Fleg, Jerome;Keteyian, Steven J.;Kraus, William E.;Pina, Ileana L.;Whellan, David;O'Connor, Christopher M.
To examine the association between baseline beta-blocker (BB) dose and outcomes in the HF-ACTION trial. BBs reduce morbidity and mortality in chronic heart failure (HF) patients with reduced ejection fraction, but it is unclear whether titrating to higher BB doses improves outcomes in this setting. HF-ACTION was a randomized, multicenter trial enrolling 2331 ambulatory HF patients with systolic dysfunction (New York Heart Association class II–IV, left ventricular ejection fraction <0.35) randomized to exercise training vs. usual care, with median follow-up of 2.5 years. BB dose at baseline was standardized using carvedilol equivalents and analyzed as a continuous variable and by discrete dose groups. The relationship between BB dose and the primary endpoint of all-cause mortality or all-cause hospitalization, and other cardiovascular secondary endpoints, was determined before and after adjustment for variables significantly associated with outcomes in the HF-ACTION cohort. 95% of patients were on a BB. There was a significant inverse relationship between BB dose and all-cause death or hospitalization but not other cardiovascular endpoints after adjustment for other predictors of outcome, with a linear benefit up to the 50 mg daily dose. There was a significant inverse association between BB dose and change in peak VO2 at 3 months. There was no increase in bradycardia with higher doses of BB. There was a significant inverse relationship between BB dose and the endpoint of all-cause death or all-cause hospitalization in this well-treated HF cohort with systolic dysfunction, supporting recommendations that titrating doses up to 50 mg per day may confer a benefit in such patients. (HF-ACTION) ClinicalTrials.gov, identifier NCT00047437
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