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; Sheyu  Li

doi:10.3389/fphar.2021.770239

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)

Research output: Contribution to journal › Article › peer-review

3 Citations (Scopus)

124 Downloads (Pure)

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 language	English
Article number	770239
Number of pages	10
Journal	Frontiers in Pharmacology
Volume	12
DOIs	https://doi.org/10.3389/fphar.2021.770239
Publication status	Published - 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

ASJC Scopus subject areas

Pharmacology
Pharmacology (medical)

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10.3389/fphar.2021.770239Licence: CC BY

Final Published VersionFinal published version, 1.56 MBLicence: CC BY

Cite this

Zhou, Y., Zeng, Y., Wang, S., Li, N., Wang, M., Mordi, I., Ren, Y., Zhou, Y., Zhu, Y., Tian, H., Sun, X., Chen, X., An, Z., Lang, C., & Li, S. (2021). Guideline adherence of β-blocker initiating dose and its consequence in hospitalized patients with heart failure with reduced ejection fraction. Frontiers in Pharmacology, 12, Article 770239. https://doi.org/10.3389/fphar.2021.770239

@article{11c8d222da4e4d80a126bdf40fbbc710,

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

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.",

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",

author = "Yiling Zhou and Yuping Zeng and Si Wang and Nan Li and Miye Wang and Ify Mordi and Yan Ren and Youlian Zhou and Ye Zhu and Haoming Tian and Xin Sun and Xiaoping Chen and Zhenmei An and Chim Lang and Sheyu Li",

note = "SL received grants from the Sichuan Science and Technology Program (Grant Number 2019YFH0150) and the 1.3.5 Project for Disciplines of Excellence, West China Hospital, Sichuan University (Grant Number ZYGD18022 and 20HXFH011), National Natural Science Foundation of China (Grant Number 21534008), and the Chief Scientist Office Project (reference number CGA/19/10). YEZ received grants from National Key Development Plan for Precision Medicine Research (Grant Number 2017YFC0910004), the Sichuan Science and Technology Program (Grant Number 2016JY0151), and National Natural Science Foundation of China (Grant Number 81601012). ",

year = "2021",

month = nov,

day = "16",

doi = "10.3389/fphar.2021.770239",

language = "English",

volume = "12",

journal = "Frontiers in Pharmacology",

issn = "1663-9812",

publisher = "Frontiers Media S.A.",

}

TY - JOUR

T1 - Guideline adherence of β-blocker initiating dose and its consequence in hospitalized patients with heart failure with reduced ejection fraction

AU - Zhou, Yiling

AU - Zeng, Yuping

AU - Wang, Si

AU - Li, Nan

AU - Wang, Miye

AU - Mordi, Ify

AU - Ren, Yan

AU - Zhou, Youlian

AU - Zhu, Ye

AU - Tian, Haoming

AU - Sun, Xin

AU - Chen, Xiaoping

AU - An, Zhenmei

AU - Lang, Chim

AU - Li, Sheyu

N1 - SL received grants from the Sichuan Science and Technology Program (Grant Number 2019YFH0150) and the 1.3.5 Project for Disciplines of Excellence, West China Hospital, Sichuan University (Grant Number ZYGD18022 and 20HXFH011), National Natural Science Foundation of China (Grant Number 21534008), and the Chief Scientist Office Project (reference number CGA/19/10). YEZ received grants from National Key Development Plan for Precision Medicine Research (Grant Number 2017YFC0910004), the Sichuan Science and Technology Program (Grant Number 2016JY0151), and National Natural Science Foundation of China (Grant Number 81601012).

PY - 2021/11/16

Y1 - 2021/11/16

N2 - 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.

AB - 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.

KW - adverse events < patient safety

KW - beta blocker

KW - electronic medical records

KW - guideline adherence [MeSH term]

KW - heart failure

KW - heart failure with reduced ejection fraction

KW - hospitalization

KW - inverse probability weighting

UR - https://www.scopus.com/pages/publications/85120540027

U2 - 10.3389/fphar.2021.770239

DO - 10.3389/fphar.2021.770239

M3 - Article

C2 - 34899323

SN - 1663-9812

VL - 12

JO - Frontiers in Pharmacology

JF - Frontiers in Pharmacology

M1 - 770239

ER -

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

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Keywords

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