Skip to main content
Journal cover image

Dosing of beta-blocker therapy before, during, and after hospitalization for heart failure (from Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure).

Publication ,  Journal Article
Fonarow, GC; Abraham, WT; Albert, NM; Stough, WG; Gheorghiade, M; Greenberg, BH; O'Connor, CM; Sun, JL; Yancy, CW; Young, JB
Published in: Am J Cardiol
December 1, 2008

Heart failure (HF) guidelines recommend that beta blockers be titrated to achieve the target doses shown to be effective in major clinical trials, if tolerated. Little is known, however, regarding the doses of beta blockers used in patients with HF in routine clinical practice before, during, and after hospitalization for HF. The Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure (OPTIMIZE-HF) enrolled 5,791 patients admitted with HF in a registry with prespecified 60- to 90-day follow-up at 91 academic and community hospitals throughout the United States. Among 2,373 patients with systolic HF eligible for beta blockers at discharge, 1,350 (56.9%) were receiving beta-blocker therapy before admission and continued on therapy, and 632 (26.6%) were newly started. The mean total daily dose for beta blockers before hospital admission was <1/2 the recommended target dose (carvedilol 21.5 +/- 17.8 mg and metoprolol succinate 69.2 +/- 51.9 mg), with infrequent up- or down-titration during the HF hospitalization. More than 2/3 of patients had no change in their beta-blocker doses in the first 60 to 90 days after hospital discharge. At 60- to 90-day postdischarge follow-up, only 17.5% and 7.9% of patients were being treated with recommended target doses of carvedilol and metoprolol succinate, respectively. In conclusion, these data reveal that the doses of beta blockers applied in clinical practice are substantially less that the doses achieved in randomized clinical trials in HF and recommended in national guidelines. In the first 60 to 90 days after hospital discharge, little up-titration in beta-blocker dosing occurs. Further efforts are needed to help understand and overcome this beta-blocker titration gap.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

Am J Cardiol

DOI

EISSN

1879-1913

Publication Date

December 1, 2008

Volume

102

Issue

11

Start / End Page

1524 / 1529

Location

United States

Related Subject Headings

  • Ventricular Function, Left
  • Time Factors
  • Systole
  • Stroke Volume
  • Registries
  • Prospective Studies
  • Propanolamines
  • Metoprolol
  • Male
  • Humans
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Fonarow, G. C., Abraham, W. T., Albert, N. M., Stough, W. G., Gheorghiade, M., Greenberg, B. H., … Young, J. B. (2008). Dosing of beta-blocker therapy before, during, and after hospitalization for heart failure (from Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure). Am J Cardiol, 102(11), 1524–1529. https://doi.org/10.1016/j.amjcard.2008.07.045
Fonarow, Gregg C., William T. Abraham, Nancy M. Albert, Wendy Gattis Stough, Mihai Gheorghiade, Barry H. Greenberg, Christopher M. O’Connor, Jie Lena Sun, Clyde W. Yancy, and James B. Young. “Dosing of beta-blocker therapy before, during, and after hospitalization for heart failure (from Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure).Am J Cardiol 102, no. 11 (December 1, 2008): 1524–29. https://doi.org/10.1016/j.amjcard.2008.07.045.
Fonarow, Gregg C., et al. “Dosing of beta-blocker therapy before, during, and after hospitalization for heart failure (from Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure).Am J Cardiol, vol. 102, no. 11, Dec. 2008, pp. 1524–29. Pubmed, doi:10.1016/j.amjcard.2008.07.045.
Fonarow GC, Abraham WT, Albert NM, Stough WG, Gheorghiade M, Greenberg BH, O’Connor CM, Sun JL, Yancy CW, Young JB. Dosing of beta-blocker therapy before, during, and after hospitalization for heart failure (from Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure). Am J Cardiol. 2008 Dec 1;102(11):1524–1529.
Journal cover image

Published In

Am J Cardiol

DOI

EISSN

1879-1913

Publication Date

December 1, 2008

Volume

102

Issue

11

Start / End Page

1524 / 1529

Location

United States

Related Subject Headings

  • Ventricular Function, Left
  • Time Factors
  • Systole
  • Stroke Volume
  • Registries
  • Prospective Studies
  • Propanolamines
  • Metoprolol
  • Male
  • Humans