Beta blockers in older persons with heart failure: tolerability and impact on quality of life

A J Baxter, A Spensley, A Hildreth, G Karimova, J E O'Connell, C S Gray, A J Baxter, A Spensley, A Hildreth, G Karimova, J E O'Connell, C S Gray

Abstract

Objective: To determine tolerability and symptom changes associated with the introduction of bisoprolol treatment in older patients with heart failure.

Design: Prospective observational cohort study.

Setting: Geriatric medicine outpatient department of a university hospital.

Patients: 51 patients (mean age 78 years, range 70-89 years) with stable symptomatic heart failure caused by left ventricular systolic dysfunction.

Interventions: Bisoprolol tablets, 1.25-10.0 mg.

Main outcome measures: Tolerability; changes in symptoms and exercise tolerance.

Results: 69% of patients tolerated bisoprolol. Mean tolerated dose was 7.6 mg. There was no change in symptoms or exercise capacity in those who tolerated bisoprolol. Perceived health status and symptoms of anxiety and depression improved during the titration period.

Conclusions: The rate of withdrawal from bisoprolol treatment in older patients with congestive heart failure was twice that previously reported in younger patients. The mean tolerated dose was similar to that found in trials reporting clinical efficacy. There was no evidence of a negative impact on symptoms or exercise capacity in patients who tolerated bisoprolol.

Figures

Figure 1
Figure 1
Changes in mean systolic and diastolic blood pressure during the test dose observation period.

References

    1. CIBIS-II Investigators. The cardiac insufficiency bisoprolol study II (CIBIS-II): a randomised trial. Lancet 1999;353:9–13.
    1. MERIT-HF Study Group. Effect of metoprolol CR/XL in chronic heart failure: metoprolol CR/XL randomised intervention trial in congestive heart failure (MERIT-HF). Lancet 1999;353:2001–7.
    1. Sharpe N. Benefit of β-blockers for heart failure: proven in 1999. Lancet 1999;353:2000.
    1. Cowie MR, Wood DA, Coats AJS, et al. Incidence and aetiology of heart failure: a population based study. Eur Heart J 1999;6:421–8.
    1. Cowie MR, Mosterd A, Wood DA, et al. The epidemiology of heart failure. Eur Heart J 1997;18:208–25.
    1. Ho KK, Pinsky JL, Kannel WB, et al. The epidemiology of heart failure: the Framingham Study. J Am Coll Cardiol 1993;22:6–13.
    1. McDonagh TA, Morrison CE, Lawrence A, et al. Symptomatic and asymptomatic left ventricular dysfunction in an urban population. Lancet 1997;350:829–33.
    1. Schiller NB, Acquatella H, Ports TA, et al. Left ventricular volume from paired biplane two dimensional echocardiography. Circulation 1979;60:547–55.
    1. Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189–98.
    1. Guyatt GH, Nogradi S, Halcrow S, et al. Development and testing of a new measure of health status for clinical trials in heart failure. J Intern Med 1989;4:101–7.
    1. O’Keefe ST, Lye M, Donnellan C, et al. Reproducibility and responsiveness of quality of life assessment and six minute walk test in elderly heart failure patients. Heart 1998;80:377–82.
    1. Goldberg DP, Hillier VF. A scaled version of the general health questionnaire. Psychol Med 1979;9:139–45.
    1. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand 1983;67:361–70.
    1. Crabtree HL, Gray CS, Hildreth AJ, et al. The comorbidity symptom scale: a combined disease inventory and assessment of symptom severity. J Am Geriatr Soc 2000;48:1674–8.
    1. Guyatt GH, Pugsley SO, Sulivan MJ, et al. The 6 minute walk test: a new measure of exercise capacity in patients with chronic heart failure. Can Med Assoc J 1985;132:919–23.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe