title: Effect of a community heart failure clinic on uptake of beta blockers by patients with obstructive airways disease and heart failure.
abstract: OBJECTIVE
  To determine the pattern of beta blocker prescribing over one year in a heart failure clinic with a structured approach towards initiation and dose titration and to give a real life perspective on beta blocker use, compliance, and target dose achievement.
  
  
  METHODS
  Data were retrospectively analysed on 513 consecutive patients regularly attending a community heart failure clinic over a year. Systolic dysfunction was determined from two dimensional echocardiography (left ventricular ejection fraction < or = 40%) and lung function was assessed by spirometry. All patients were considered for beta blocker initiation and dose up titration.
  
  
  RESULTS
  Within one year 157 patients died. 143 patients started beta blockers resulting in 315 (88%) patients taking beta blockers at one year; 38% were taking the target dose. 124 had evidence of airways obstruction at baseline, 100 (81%) of whom were taking beta blockers at one year. Forced expiratory volume in one second (1.1 v 1.5 l, p < 0.01) and forced vital capacity (2.3 v 2.5 l/min, p = 0.2) were not reduced in patients with airways obstruction who received beta blockers. Daily doses of beta blockers at one year did not differ statistically between patients with obstructive and patients with non-obstructive spirometry results. 12 patients discontinued beta blockers and 14 required dose reduction due to side effects.
  
  
  CONCLUSIONS
  The majority of patients with heart failure and obstructive airways disease can safely tolerate low dose initiation and gradual up titration of beta blockers.
authors.affiliation: Department of Academic Cardiology, Castle Hill Hospital, University of Hull, Kingston-upon-Hull, UK. rhidianshelton@btopenworld.com
authors.forename: R J
authors.initials: RJ
authors.lastname: Shelton
authors.forename: A S
authors.initials: AS
authors.lastname: Rigby
authors.forename: J G F
authors.initials: JG
authors.lastname: Cleland
authors.forename: A L
authors.initials: AL
authors.lastname: Clark
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage*; D000368:Aged; D000553:Ambulatory Care; D003153:Community Health Services; D005260:Female; D005541:Forced Expiratory Volume / Q000187:drug effects; D006333:Heart Failure / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D008297:Male; D010342:Patient Acceptance of Health Care; D010349:Patient Compliance; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000503:physiopathology; D012189:Retrospective Studies; D014797:Vital Capacity / Q000187:drug effects
chemical_list: D000319:Adrenergic beta-Antagonists