CARDIOVASCULAR MEDICINE

Effect of a community heart failure clinic on uptake of ß blockers by patients with obstructive airways disease and heart failure

R J Shelton, A S Rigby, J G F Cleland, A L Clark

Department of Cardiology, Castle Hill Hospital, University of Hull, Kingston-upon-Hull, UK

Correspondence to:
Dr Rhidian J Shelton
Department of Academic Cardiology, Castle Hill Hospital, Cottingham, Kingston-upon-Hull HU16 5JQ, UK; rhidianshelton{at}btopenworld.com

Objective: To determine the pattern of ß blocker prescribing over one year in a heart failure clinic with a structured approach towards initiation and dose titration and to give a real life perspective on ß blocker use, compliance, and target dose achievement.

Methods: Data were retrospectively analysed on 513 consecutive patients regularly attending a community heart failure clinic over a year. Systolic dysfunction was determined from two dimensional echocardiography (left ventricular ejection fraction 40%) and lung function was assessed by spirometry. All patients were considered for ß blocker initiation and dose up titration.

Results: Within one year 157 patients died. 143 patients started ß blockers resulting in 315 (88%) patients taking ß blockers at one year; 38% were taking the target dose. 124 had evidence of airways obstruction at baseline, 100 (81%) of whom were taking ß blockers at one year. Forced expiratory volume in one second (1.1 v 1.5 l, p < 0.01) and forced vital capacity (2.3 v 2.5 l/min, p = 0.2) were not reduced in patients with airways obstruction who received ß blockers. Daily doses of ß blockers at one year did not differ statistically between patients with obstructive and patients with non-obstructive spirometry results. 12 patients discontinued ß blockers and 14 required dose reduction due to side effects.

Conclusion: The majority of patients with heart failure and obstructive airways disease can safely tolerate low dose initiation and gradual up titration of ß blockers.

Keywords: heart failure; ß blockers; chronic obstructive pulmonary disease

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