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The Role of Betablocker in Heart Failure: - Perspective From Comorbidities
The Role of Betablocker in Heart Failure: - Perspective From Comorbidities
HEART FAILURE
- PERSPECTIVE FROM COMORBIDITIES -
The importance of
ACEi/ARBs/ARNI, Beta blocker, MRA,
and Ivabradine
Neurohormonal imbalanced in HF is characterized by
sustained overactivation of RAAS and SNS with attenuation of
the effects of NPs
Balancing neurohormonal in heart failure
Elevated resting HR in cardiovascular disease
Comorbidities and heart failure
Survival Heart failure re-hospitalization
• Cardioselective Beta-blockers :
Bisoprolol is unique in being almost
14 times more selective for beta1
(cardiac) than for beta2 receptors
(bronchial)
Spencer R, Serumaga B. Prescriber 19 February 2012.
COMORBIDITIES in HF
o Anaemia o Liver dysfunction
o Stroke o Gout
o Angina o Hyperlipidemia
o Asthma & COPD o Hypertension
o Cachexia o Kidney dysfunction
o Cancer o Obesity
o Diabetes o Sleep disordered breathing
o Depression o Thyroid dysfunction
o GI problems o Erectile dysfunction
o Electrolyte imbalance o Arrhythmias
Beta blocker use in subjects with type 2 diabetes mellitus
and systolic heart failure does not worsen glycaemic control
ACEi/ARB
β-blocker
Recent Guidelines on Heart Failure
The importance of
Comorbidities – underlying causes
(incl. Thyroid disorders)
COMORBIDITIES in HF
o Anaemia o Liver dysfunction
o Stroke o Gout
o Angina o Hyperlipidemia
o Asthma & COPD o Hypertension
o Cachexia o Kidney dysfunction
o Cancer o Obesity
o Diabetes o Sleep disordered breathing
o Depression o Thyroid dysfunction
o GI problems o Erectile dysfunction
o Electrolyte imbalance o Arrhythmias – atrial fibrillation
CONCLUSION: Based on the potential risks and benefits, as well as the
presence of alternative drugs, there is a limited role for digoxin in the
management of patients with normal sinus rhythm and congestive heart
failure. Based on the retrospective studies reviewed there is a growing
volume of data showing increased mortality in those with only atrial
fibrillation. The proper role of digoxin is, however, less certain in other
subgroups of patients, such as those with both atrial fibrillation and systolic
congestive heart failure or after a myocardial infarction.
Beta-Blockers Or Digoxin For
Atrial Fibrillation And Heart Failure?
- A Review -
Conclusion
• Rate control therapy most often includes a beta-blocker,
• Digoxin is mainly given to elderly AF patients with HF ; Consequently,
its use is associated with increased crude rates of mortality
• it is unclear whether digoxin has a clear independent association with
increased mortality.
• it should be reserved for rate control in AF patients who are sedentary
or who have left ventricular systolic dysfunction, particularly when
beta-blockers do not achieve sufficient rate control and when they are
poorly tolerated or contraindicated.
Erdmann E, European Heart Journal Supplements, Volume 11, Issue suppl_A, March 2009, Pages A21–A25
The importance of HR in CVD
(Betablokers : Beyond HR reducer)
Which beta blocker ?
ESC Guidelines on HF 2016
Canadian Guidelines on HF 2017