The use of guideline recommended beta-blocker therapy in primary prevention implantable cardioverter defibrillator patients: insight from Danish nationwide registers.
We aimed to examine the use of guideline recommended beta-blocker therapy prior to and after primary prevention implantable cardioverter defibrillator (ICD) implantation in a 'real-life' setting.



From the Danish Pacemaker and ICD Registry we identified all 1st-time primary prevention ICD and cardiac resynchronization therapy defibrillator (CRT-D) implantations in Denmark from 2007-12 (n = 2935). Use of beta-blocker, type and dose was acquired through the Danish Prescription Registry. According to guideline recommendations, we defined target daily doses as ≥50 mg carvedilol and ≥200 mg metoprolol. Prior to implantation 2427 of 2935 (83%) patients received beta-blocker therapy, with 2166 patients (89%) having initiated treatment 3 months or more prior to implantation. The majority of patients was prescribed carvedilol (52%) or metoprolol (41%). Patients on carvedilol reached target dosages more frequently than patients on metoprolol, with 39% of patients on carvedilol and 26% of patients on metoprolol at the time of implantation (P < 0.001 for all time-points). Increase in proportion of patients reaching target daily doses was observed for both carvedilol and metoprolol after ICD implantation. Carvedilol treatment was a strong predictor for being on target dose of BB at time of implant, as was treatment with angiotensin-converting enzyme inhibitors and/or spironolactone, no history of myocardial infarction, younger age and less pronounced heart failure symptoms.



In a real-life setting of primary prevention ICD patients, 39% and 26% of patients were titrated to optimal target dose of carvedilol or metoprolol prior to implantation. A higher proportion of patients on carvedilol reached target dose, as compared with metoprolol.
Department of Cardiology, Herlev-Gentofte University Hospitals, Copenhagen, Denmark.
Anne-Christine
AC
Ruwald
Department of Cardiology, Herlev-Gentofte University Hospitals, Copenhagen, Denmark.|National Institute of Public Health, Copenhagen, Denmark.|Department of Cardiology, University of Southern Denmark, Odense, Denmark.|The Danish Heart Foundation.
Gunnar Hilmar
GH
Gislason
Department of Cardiology, Herlev-Gentofte University Hospitals, Copenhagen, Denmark.
Michael
M
Vinther
Department of Cardiology, Odense University Hospital, Odense, Denmark.
Jens Brock
JB
Johansen
Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
Jens Cosedis
JC
Nielsen
Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.
Helen Høgh
HH
Petersen
Department of Clinical Epidemiology, Aalborg University Hospital, Aalborg, Denmark.
Christian
C
Torp-Pedersen
Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.
Sam
S
Riahi
Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.
Christian
C
Jøns
D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage* / Q000009:adverse effects; D000368:Aged; D002227:Carbazoles / Q000008:administration & dosage* / Q000009:adverse effects; D000077261:Carvedilol; D016757:Death, Sudden, Cardiac / Q000517:prevention & control*; D017147:Defibrillators, Implantable / Q000592:standards; D003718:Denmark; D004554:Electric Countershock / Q000009:adverse effects / Q000295:instrumentation* / Q000592:standards; D005260:Female; D019983:Guideline Adherence / Q000592:standards; D006801:Humans; D008297:Male; D008790:Metoprolol / Q000008:administration & dosage* / Q000009:adverse effects; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards; D011322:Primary Prevention / Q000379:methods* / Q000592:standards; D011412:Propanolamines / Q000008:administration & dosage* / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
D000319:Adrenergic beta-Antagonists; D002227:Carbazoles; D011412:Propanolamines; D000077261:Carvedilol; D008790:Metoprolol
Carvedilol ; Heart failure ; Metoprolol ; Predictors; Target dose ; Treatment 