Abstract 13341: Beneficial Effects of Beta Blockers in Elderly Patients with Chronic Heart Failure Are Not Influenced by Cardiac Rhythm — Insight From the Cardiac Insufficiency Bisoprolol Study in Elderly
Objective: Although the role of beta blockers (BB) in the treatment of heart failure (HF) is undisputed, it has been suggested that patients with atrial fibrillation (AF) may respond differently to BB than those in sinus rhythm (SR).
Methods: We analyzed data from the Cardiac Insufficiency Bisoprolol Study in Elderly (CIBIS-ELD) to compare the response to BB initiation and/or uptitration in patients with AF versus those with SR. A total of 883 HF patients ≥65 years (164 patients with AF) were randomized to bisoprolol or carvedilol. During the 12-week-treatment phase, BB were doubled fortnightly up to the target dose or maximally tolerated dose, which was maintained for 4 weeks.
Results: AF was associated with lower left ventricular ejection fraction (LVEF), exercise capacity, self rated health, quality of life (QoL) scores for both SF36 physical and mental component, and higher NYHA class (p<0.05, for all). BB produced significant improvement in both AF and SR patients in: LVEF (+4.6 and +2.4%), 6-minute walk distance (+14.3 and +16.1 m), physical (+2.3 and +2.2) and mental components (+2.6 and +3.4) of QoL scores, self rated health (−0.32 and -0.33) and NYHA class (−0.28 and -0.27; p<0.05, for all). The extent of the improvement, however, did not differ between patients in AF and SR (p>0.05, for all adjusted mean differences between AF and SR group, from ANCOVA). HR at baseline was higher in the AF group, and remained higher until the end of the trial (86 vs. 71 and 77 vs. 64 bpm, respectively; p<0.001 for both). Although mean HR reductions were comparable between groups (−9.2 in AF and -6.2 bpm in SR group, p>0.05), large reductions (>20 bpm) occurred more often in patients with AF (20% vs. 11% p<0.05). AF patients more frequently reached target BB dose compared to those in SR (42% vs. 29% p<0.005).
Conclusions: HF patients with AF derived comparable clinical benefits from BB therapy as those in SR. Due to higher baseline HR, patients with AF tolerated higher BB doses than those with SR.
- © 2010 by American Heart Association, Inc.