Programme to improve the use of beta-blockers for heart failure in the elderly and in those with severe symptoms: results of the BRING-UP 2 Study.
BACKGROUND
Beta-blockers are underused in HF patients, thus strategies to implement their use are needed.


OBJECTIVE
To improve beta-blocker use in elderly and/or patients with severe heart failure (HF) and to evaluate safety and outcome.


METHODS
Patients with symptomatic HF and age>/=70 years or left ventricular EF<25% and symptoms at rest were enrolled, including those already on beta-blocker treatment. Patients who were not receiving a beta-blocker were considered for carvedilol treatment. All patients were followed up for 1-year.


RESULTS
Of the 1518 elderly patients, 505 were already on beta-blockers, and carvedilol was newly prescribed in 419 patients. At 1-year, patients treated with carvedilol had a lower incidence of death [10.8% vs. 18.0% in already treated (adjusted RR 0.68; 95%CI 0.49-0.96) and 11.2% in newly treated patients (adjusted RR 0.68; 95%CI 0.48-0.97)]. Of the 709 patients with severe HF, 38.4% were already on beta-blockers, and carvedilol was newly prescribed in 189 patients. Patients not treated with carvedilol showed the worst clinical outcome. Total rate of discontinuation (including adverse reaction and non-compliance) was 14% and 9%, respectively, in elderly and severe patients.


CONCLUSIONS
In a real world setting, beta-blocker treatment was not associated with an increased risk of adverse events in elderly and severe HF patients.
Opasich
Cristina
C
Department of Cardiology, Salvatore Maugeri Foundation, Pavia, Italy.
Boccanelli
Alessandro
A
Cafiero
Massimo
M
Cirrincione
Vincenzo
V
Sindaco
Donatella Del
DD
Lenarda
Andrea Di
AD
Luzio
Silvia Di
SD
Faggiano
Pompilio
P
Frigerio
Maria
M
Lucci
Donata
D
Porcu
Maurizio
M
Pulignano
Giovanni
G
Scherillo
Marino
M
Tavazzi
Luigi
L
Maggioni
Aldo P
AP
D000319:Adrenergic beta-Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D000367:Age Factors; D000368:Aged; D002227:Carbazoles / Q000009:adverse effects / Q000627:therapeutic use*; D002303:Cardiac Output, Low / Q000188:drug therapy* / Q000503:physiopathology; D000077261:Carvedilol; D002908:Chronic Disease; D004363:Drug Utilization; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D010353:Patient Education as Topic; D017410:Practice Guidelines as Topic; D016730:Program Development; D015397:Program Evaluation; D011412:Propanolamines / Q000009:adverse effects / Q000627:therapeutic use*; D012720:Severity of Illness Index; D013318:Stroke Volume / Q000187:drug effects; D016896:Treatment Outcome
D000319:Adrenergic beta-Antagonists; D002227:Carbazoles; D011412:Propanolamines; D000077261:Carvedilol