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- ACE, angiotensin converting enzyme
- ARB, angiotensin receptor blocker
- CHF, chronic heart failure
- CTx, cardiac transplantation
- HFSS, heart failure survival score
- LVEF, left ventricular ejection fraction
- LVSD, left ventricular systolic dysfunction
- NT-proBNP, N terminal pro-brain natriuretic peptide
- NYHA, New York Heart Association
- V̇o2, oxygen uptake
Severe chronic heart failure (CHF) can still be associated with an annual mortality of up to 51%.1 Over the last seven years, β blockers have been conclusively shown to improve both morbidity and mortality in heart failure, even in its advanced stages.2,3 However, a recent report suggests β blocker use in CHF is still not widespread.4 This may be due to non-specialist care, perceived or actual difficulty establishing patients on this treatment, or perhaps the recollection of old teachings on the dangers of β blockade in heart failure.
This study describes the experience of β blockade and its effects in patients with CHF caused by severe left ventricular systolic dysfunction (LVSD), and seeks to extend the importance of the clinical trial data into the real world.
We retrospectively studied the effects of baseline β blocker use in 128 consecutive patients with advanced heart failure on their referral to the Scottish Cardiopulmonary Transplant Unit for cardiac transplantation (CTx) assessment between April 2001 and August 2002. Treatment on initial assessment was documented and subsequently optimised. Patients had their left ventricular ejection fraction (LVEF) measured by radionuclide ventriculography and, where possible, a progressive exercise test to quantify their peak oxygen uptake (V̇o2). A baseline heart failure survival score (HFSS) was calculated for each patient. The primary end point was all cause mortality and the secondary end point was all cause mortality or urgent transplantation. Urgent transplantation is considered in suitable inotrope dependent patients with end stage heart failure who have an anticipated life expectancy of less than one week. Patients …