The Use of -Blockers in a Tertiary Care Heart Failure Clinic

Methods: Analysis of prospectively collected data from acohortof1041patientswithheartfailureseenattheUniversityofAlbertaHeartFunctionClinic,Edmonton,from September 1, 1989, through July 1, 2001, with objective measurementofejectionfractionatbaselineandprospective collection of data at all subsequent clinic visits. Results:Median age at baseline was 69 years; 65% were male; 75% had systolic dysfunction; mean ejection fraction was 33%; and 51% had New York Heart Association class III or IV symptoms. Median duration of follow-up was 32 months (interquartile range, 13-62 months). Overall, 46% of patients received -blockers, butonly18%ofthesewereultimatelyprescribedthedosages achieved in the trials (mean maximum dosages achieved, 27 mg/d for carvedilol and 81 mg/d for metoprolol tartrate). Of those patients prescribed -blockers, 74% continued to receive them during follow-up. Blood pressure, heart rate, and failure symptomatology did not change appreciably before and after -blockers were prescribed, or during the upward titration of the dosage.Althoughourpatientswereprescribedlowerdosages than those used in trials, Cox multivariate regression revealed that -blockers were associated with improved survival, even after adjusting for potential confoundersincludingNewYorkHeartAssociationclass, year of prescription, and concomitant medication use (relative risk, 0.63; 95% confidence interval, 0.50-0.81). Conclusions: The benefits of -blockers seen in randomized trials extend to nontrial participants treated in a tertiary care clinic specializing in heart failure. In our cohort of elderly patients with multiple comorbidities, -blockers were well tolerated. Arch Intern Med. 2004;164:769-774