Guideline adherence of β-blocker initiating dose and its consequence in hospitalized patients with heart failure with reduced ejection fraction

Yiling Zhou, Yuping Zeng, Si Wang, Nan Li, Miye Wang, Ify Mordi, Yan Ren, Youlian Zhou, Ye Zhu, Haoming Tian, Xin Sun, Xiaoping Chen, Zhenmei An, Chim Lang (Lead / Corresponding author), Sheyu Li (Lead / Corresponding author)

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Abstract

Background: We aim to investigate the guideline adherence of β-blocker (BB) initiating dose in Chinese hospitalized patients with heart failure with reduced ejection fraction (HFrEF) and whether the adherence affected the in-hospital outcomes.

Methods: This was a retrospective study of patients hospitalized with HFrEF who had initiated BBs during their hospitalization. We defined adherence to clinical practice guidelines as initiating BB with standard dose and non-adherence to guidelines if otherwise, and examined the association between adherence to guidelines and in-hospital BB-related adverse events. Subgroup analyses based on sex, age, coronary heart disease, and hypertension were performed.

Results: Among 1,104 patients with HFrEF initiating BBs during hospitalization (median length of hospitalization, 12 days), 304 (27.5%) patients received BB with non-adherent initiating dose. This non-adherence was related to a higher risk (hazard ratio [95% confidence interval]) of BB dose reduction or withdrawal (1.78 [1.42 to 2.22], P < 0.001), but not significantly associated with risks of profound bradycardia, hypotension, cardiogenic shock requiring intravenous inotropes, and severe bronchospasm requiring intravenous steroid during hospitalization.

Conclusion: This study identified that over a fourth of patients had received BBs with an initiating dose that was not adherent to guidelines in Chinese hospitalized patients with HFrEF, and this non-adherence was associated with BB dose reduction or withdrawal during hospitalization.

Original languageEnglish
Article number770239
Number of pages10
JournalFrontiers in Pharmacology
Volume12
DOIs
Publication statusPublished - 16 Nov 2021

Keywords

  • adverse events < patient safety
  • beta blocker
  • electronic medical records
  • guideline adherence [MeSH term]
  • heart failure
  • heart failure with reduced ejection fraction
  • hospitalization
  • inverse probability weighting

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