Abstract 12023: Relationship of Beta-Blocker (BB) Dose with Outcomes in Ambulatory Heart Failure (HF) Patients with Systolic Dysfunction: Results from the HF-ACTION Trial
Background: Beta-blockers are the mainstay of pharmacologic therapy and reduce morbidity/mortality in HF patients with reduced ejection fraction. Little is known about the importance of BB dose in modern day treated ambulatory HF patients. We examined the impact of baseline BB dose on exercise parameters and outcomes in the HF-ACTION study population.
Methods: HF-ACTION was a randomized, multi-center trial enrolling 2331 ambulatory HF patients with systolic dysfunction (NYHA class II-IV, left ventricular ejection fraction (LVEF) <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. All-cause mortality and all-cause hospitalization (hosp), and mortality alone were determined and adjusted using variables found to be significantly associated with outcomes.
Results: 95% of patients were on a BB, with 36% receiving 25-50mg daily, and 31% receiving 13-25mg daily. The dose response relationship for all-cause death/hosp is shown in Figure 1, and clinical outcomes are shown in Table 1.
Conclusion: There was a broad distribution of doses in this ambulatory cohort of systolic dysfunction HF patients. There was a significant dose-response relationship with the combined endpoint of death/hosp, suggesting that higher doses up to 50mg/day may confer greater benefit in this ambulatory HF cohort of patients, an association which should be tested prospectively.
- © 2011 by American Heart Association, Inc.