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Beta blockers and chronic heart failure patients: prognostic impact of a dose targeted beta blocker therapy vs. heart rate targeted strategy

  • Anna Corletto
  • Hanna Fröhlich
  • Tobias Täger
  • Matthias Hochadel
  • Ralf Zahn
  • Caroline Kilkowski
  • Ralph Winkler
  • Jochen Senges
  • Hugo A. Katus
  • Lutz Frankenstein
Original Paper

Abstract

Background

Beta blockers improve survival in patients with chronic systolic heart failure (CHF). Whether physicians should aim for target dose, target heart rate (HR), or both is still under debate.

Methods and Results

We identified 1,669 patients with systolic CHF due to ischemic heart disease or idiopathic dilated cardiomyopathy from the University Hospital Heidelberg and the Clinic of Ludwigshafen, Germany. All patients were treated with an angiotensin converting enzyme inhibitor or angiotensin receptor blocker and had a history of CHF known for at least 6 months. Target dose was defined as treatment with ≥ 95% of the respective published guideline-recommended dose. Target HR was defined as 51–69 bpm. All-cause mortality during the median follow-up of 42.8 months was analysed with respect to beta blocker dosing and resting HR. 201 (12%) patients met the dose target (group A), 285 (17.1%) met the HR target (group B), 627 (37.6%) met no target (group C), and 556 (33.3%) did not receive beta blockers (Group D). 5-year mortality was 23.7, 22.7, 37.6, and 55.6% for group A, B, C, and D, respectively (p <  0.001). Survival for group A patients with a HR ≥ 70 bpm was 28.8% but 14.8% if HR was 50–70 bpm (p = 0.054).

Conclusions

Achieving guidelines recommended beta blocker dose or to HR control has a similar positive impact on survival. When on target dose, supplemental HR control additionally improves survival.

Keywords

Heart failure Beta blocker Clinic Heart rate 

Notes

Funding

For the Klinikum Ludwigshafen, the clinical register underlying this analysis was founded by an unrestricted grant from the Insitut für Herzinfarktforschung Ludwigshafen.

Compliance with ethical standards

Conflict of interest

The authors declare that there is no conflict of interest.

Supplementary material

392_2018_1277_MOESM1_ESM.docx (47 kb)
Supplementary material 1 (DOCX 46 KB)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Anna Corletto
    • 1
  • Hanna Fröhlich
    • 1
  • Tobias Täger
    • 1
  • Matthias Hochadel
    • 2
  • Ralf Zahn
    • 2
  • Caroline Kilkowski
    • 2
  • Ralph Winkler
    • 2
  • Jochen Senges
    • 3
  • Hugo A. Katus
    • 1
  • Lutz Frankenstein
    • 1
  1. 1.Department of Cardiology, Angiology, and PulmologyUniversity of HeidelbergHeidelbergGermany
  2. 2.Medizinische Klinik B-Abteilung für Kardiologie, Klinikum der Stadt Ludwigshafen GmbHLudwigshafen am RheinGermany
  3. 3.Stiftung Institut für HerzinfarktforschungLudwigshafen am RheinGermany

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