Impact of metoprolol treatment on mental status of chronic heart failure patients with neuropsychiatric disorders.
BACKGROUND
Metoprolol treatment is well established for chronic heart failure (CHF) patients, but the central nervous system side effects are often a potential drawback.


OBJECTIVE
To investigate the impact of metoprolol treatment on change in mental status of CHF patients with clinical psychological disorders (such as depression, anxiety, and burnout syndrome).


METHODS
From February 2013 to April 2016, CHF patients with clinical mental disorders received metoprolol (23.75 or 47.5 mg, qd PO, dose escalated with 23.75 mg each time until target heart rate [HR] <70 bpm was achieved) at the Second Affiliated Hospital of Kunming Medical University. Mental status was assessed by means of the Hospital Anxiety and Depression Scale (HADS) and the Copenhagen Burnout Inventory (CBI) scale. The primary outcome assessed was change in mental status of patients post-metoprolol treatment and the association with reduction in HR achieved by metoprolol.


RESULTS
A total of 154 patients (median age: 66.39 years; males: n=101) were divided into eight groups on the basis of their mental status. HR decreased significantly from baseline values in all the groups to <70 bpm in the 12th month,P≤0.0001. The HADS depression and CBI scores significantly increased from baseline throughout the study frame (P≤0.0001 for all groups), but a significant decrease in the HADS anxiety score was observed in patients with anxiety (P≤0.0001 for all groups). Regression analysis revealed no significant correlation in any of the groups between the HR reduction and the change in the HADS/CBI scores, except for a change in the CBI scores of CHF patients with depression (P=0.01), which was HR dependent.


CONCLUSIONS
Metoprolol treatment worsens the depressive and high burnout symptoms, but affords anxiolytic benefits independent of HR reduction in CHF patients with clinical mental disorders. Hence, physicians need to be vigilant while prescribing metoprolol in CHF patients who present with mental disorders.
Department of Cardiology.
Xuelu
X
Liu
Department of Cardiology.
Xueming
X
Lou
Department of Endocrinology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, People's Republic of China.
Xianliang
X
Cheng
Department of Cardiology.
Yong
Y
Meng
D000284:Administration, Oral; D000368:Aged; D000959:Antihypertensive Agents / Q000009:adverse effects / Q000627:therapeutic use; D002908:Chronic Disease; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000188:drug therapy* / Q000523:psychology; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000139:chemically induced* / Q000150:complications*; D008790:Metoprolol / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use*; D009422:Nervous System Diseases / Q000139:chemically induced* / Q000150:complications*; D009483:Neuropsychological Tests; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales
D000959:Antihypertensive Agents; D008790:Metoprolol
CBI scale; HADS anxiety and depression; chronic heart failure; heart rate; high burnout; metoprolol