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Beta Blockers Up-Titration in Patients with Heart Failure Reduced Ejection Fraction and Cardiac Resynchronization Therapy, a Single Center Study

1
Heart Failure Unit, AORN Colli, 80121 Naples, Italy
2
Department of Translational Medical Sciences, Luigi Vanvitelli University, 80121 Naples, Italy
3
Institute of Cardiovascular Sciences, University College of London, London WC1E 6BT, UK
*
Author to whom correspondence should be addressed.
Med. Sci. 2019, 7(6), 71; https://doi.org/10.3390/medsci7060071
Received: 27 December 2018 / Revised: 9 June 2019 / Accepted: 14 June 2019 / Published: 18 June 2019
(This article belongs to the Section Cardiovascular Disease)
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Abstract

Clinical trials have shown the benefits of β-blockers therapy in patients with heart failure reduced ejection fraction. These benefits include improved survival and a reduced need for hospitalization. Cardiac resynchronization therapy has emerged as an essential device-based therapy for symptomatic patients with heart failure reduced ejection fraction despite optimal pharmacologic treatment. The extent to which β-blockers are being utilized in patients receiving cardiac resynchronization therapy is not well known. In this study, we evaluate the possibility of increasing β-blockers doses in an unselected cohort of heart failure reduced ejection patients after cardiac resynchronization therapy capable defibrillator system implantation and the correlation between β-blockers treatments and clinical outcome. Methods and results: Patients with heart failure reduced ejection fraction in β-blockers therapy that underwent cardiac resynchronization therapy capable defibrillator system implantation between July 2008, and December 2016 were enrolled in the study. The β-blockers dose was determined at the time of discharge and during follow-up. Cardiovascular mortality, hospitalization for worsening heart failure or arrhythmic storm and appropriate intervention of the device, were recorded. The study cohort included 480 patients, 289 patients (60.3%) had β-blockers doses equal to the dose before CRT (Group 1), 191 patients (39.7%) had higher β-blockers doses than those before the CRT implant (Group 2). Comparing the two groups, Group 2 have lower cardiovascular mortality, heart failure-related hospitalization, and arrhythmic events than Group 1. Conclusion: After initiating CRT, β-blockers could be safely up-titrated at higher doses with the reduction in mortality, heart failure-related hospitalization, and arrhythmic events. View Full-Text
Keywords: heart failure reduced ejection fraction; beta-blockers; cardiac resynchronization therapy heart failure reduced ejection fraction; beta-blockers; cardiac resynchronization therapy
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MDPI and ACS Style

Masarone, D.; Verrengia, M.; Ammendola, E.; Gravino, R.; Valente, F.; Vastarella, R.; Rubino, M.; Limongelli, G.; Pacileo, G. Beta Blockers Up-Titration in Patients with Heart Failure Reduced Ejection Fraction and Cardiac Resynchronization Therapy, a Single Center Study. Med. Sci. 2019, 7, 71.

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