Beta-blocker treatment of stable heart failure in primary care.
OBJECTIVE
Beta-blocker treatment of stable heart failure in primary care. The objective was to evaluate the feasibility and tolerability of uptitrating beta-blockers in patients with stable systolic heart failure seen in primary care.


METHODS
Before and after intervention study. The study was conducted in two primary care centers in Barcelona, Spain. Consecutive samples of patients with systolic heart failure who had not received previous beta-blocker treatment were recruited between April 2004 and April 2006. Treatment was started with the lowest dose of bisoprolol or carvedilol and the dose was doubled every two weeks in the absence of contraindications. Patients were followed up for 6 months.


RESULTS
The study included 88 patients (76.1% male, 23,9% female, mean age 64.88 years). Of these, 57.1% were treated with bisoprolol and 42.9% with carvedilol. Overall, 75.0% reached the target dose, 21.7% tolerated a dose lower than the target dose, and 3.3% had the beta-blocker withdrawn (due to bradycardia in 1.1%, syncope in 1.1%, and stroke in 1.1%). Adverse events were experienced by 70.4%, the majority of which (57.95%) were resolved without changing treatment. The most common were nausea (42.04%), asthenia (35.22%), and increased dyspnea (17.04%). There were significant improvements in functional class and ejection fraction.


CONCLUSIONS
The majority of adverse events were mild. Treatment was withdrawn in only a few patients and most reached the recommended target dose. Appropriately trained primary care physicians can uptitrate beta-blockers in heart failure patients without undue concern.
Verdú Rotellar
José M
JM
CAP Sant Martí, Institut Català de la Salut, Barcelona, España. verdujm@gmail.com
Barroso
Alberto
A
Bernáldez
María J
MJ
Domíngueza
Marcel
M
Pie
Magda
M
Sancho
Francisca
F
Simó
Montserrat
M
Domingo
Mar
M
D000317:Adrenergic alpha-Antagonists / Q000627:therapeutic use*; D000368:Aged; D017298:Bisoprolol / Q000627:therapeutic use*; D002227:Carbazoles / Q000627:therapeutic use*; D000077261:Carvedilol; D005260:Female; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D011412:Propanolamines / Q000627:therapeutic use*; D011446:Prospective Studies
D000317:Adrenergic alpha-Antagonists; D002227:Carbazoles; D011412:Propanolamines; D000077261:Carvedilol; D017298:Bisoprolol