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Achieving a Maximally Tolerated β-Blocker Dose in Heart Failure Patients: Is There Room for Improvement?

Publication ,  Journal Article
Bhatt, AS; DeVore, AD; DeWald, TA; Swedberg, K; Mentz, RJ
Published in: J Am Coll Cardiol
May 23, 2017

Heart failure (HF) is associated with significant morbidity and mortality. Although initially thought to be harmful in HF, beta-adrenergic blockers (β-blockers) have consistently been shown to reduce mortality and HF hospitalization in chronic HF with reduced ejection fraction. Proposed mechanisms include neurohormonal blockade and heart rate reduction. A new therapeutic agent now exists to target further heart rate lowering in patients who have been stable on a "maximally tolerated β-blocker dose," but this definition and how to achieve it are incompletely understood. In this review, the authors summarize published reports on the mechanisms by which β-blockers improve clinical outcomes. The authors describe differences in doses achieved in landmark clinical trials and those observed in routine clinical practice. They further discuss reasons for intolerance and the evidence behind using β-blocker dose and heart rate as therapeutic targets. Finally, the authors offer recommendations for clinicians actively initiating and up-titrating β-blockers that may aid in achieving maximally tolerated doses.

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Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

May 23, 2017

Volume

69

Issue

20

Start / End Page

2542 / 2550

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Maximum Tolerated Dose
  • Humans
  • Heart Rate
  • Heart Failure
  • Dose-Response Relationship, Drug
  • Cardiovascular System & Hematology
  • Adrenergic beta-Antagonists
  • 3201 Cardiovascular medicine and haematology
  • 1117 Public Health and Health Services
 

Citation

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Bhatt, A. S., DeVore, A. D., DeWald, T. A., Swedberg, K., & Mentz, R. J. (2017). Achieving a Maximally Tolerated β-Blocker Dose in Heart Failure Patients: Is There Room for Improvement? J Am Coll Cardiol, 69(20), 2542–2550. https://doi.org/10.1016/j.jacc.2017.03.563
Bhatt, Ankeet S., Adam D. DeVore, Tracy A. DeWald, Karl Swedberg, and Robert J. Mentz. “Achieving a Maximally Tolerated β-Blocker Dose in Heart Failure Patients: Is There Room for Improvement?J Am Coll Cardiol 69, no. 20 (May 23, 2017): 2542–50. https://doi.org/10.1016/j.jacc.2017.03.563.
Bhatt AS, DeVore AD, DeWald TA, Swedberg K, Mentz RJ. Achieving a Maximally Tolerated β-Blocker Dose in Heart Failure Patients: Is There Room for Improvement? J Am Coll Cardiol. 2017 May 23;69(20):2542–50.
Bhatt, Ankeet S., et al. “Achieving a Maximally Tolerated β-Blocker Dose in Heart Failure Patients: Is There Room for Improvement?J Am Coll Cardiol, vol. 69, no. 20, May 2017, pp. 2542–50. Pubmed, doi:10.1016/j.jacc.2017.03.563.
Bhatt AS, DeVore AD, DeWald TA, Swedberg K, Mentz RJ. Achieving a Maximally Tolerated β-Blocker Dose in Heart Failure Patients: Is There Room for Improvement? J Am Coll Cardiol. 2017 May 23;69(20):2542–2550.
Journal cover image

Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

May 23, 2017

Volume

69

Issue

20

Start / End Page

2542 / 2550

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Maximum Tolerated Dose
  • Humans
  • Heart Rate
  • Heart Failure
  • Dose-Response Relationship, Drug
  • Cardiovascular System & Hematology
  • Adrenergic beta-Antagonists
  • 3201 Cardiovascular medicine and haematology
  • 1117 Public Health and Health Services