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Effect of a community heart failure clinic on uptake of β blockers by patients with obstructive airways disease and heart failure
  1. R J Shelton,
  2. A S Rigby,
  3. J G F Cleland,
  4. A L Clark
  1. Department of Cardiology, Castle Hill Hospital, University of Hull, Kingston-upon-Hull, UK
  1. Correspondence to:
    Dr Rhidian J Shelton
    Department of Academic Cardiology, Castle Hill Hospital, Cottingham, Kingston-upon-Hull HU16 5JQ, UK; rhidianshelton{at}


Objective: To determine the pattern of β 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 β 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 β blocker initiation and dose up titration.

Results: Within one year 157 patients died. 143 patients started β blockers resulting in 315 (88%) patients taking β blockers at one year; 38% were taking the target dose. 124 had evidence of airways obstruction at baseline, 100 (81%) of whom were taking β 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 β blockers. Daily doses of β blockers at one year did not differ statistically between patients with obstructive and patients with non-obstructive spirometry results. 12 patients discontinued β 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 β blockers.

  • ACE, angiotensin converting enzyme
  • CI, confidence interval
  • COMET, carvedilol or metoprolol European trial
  • COPD, chronic obstructive pulmonary disease
  • COPERNICUS, carvedilol prospective randomised cumulative survival
  • FEV1, forced expiratory volume in one second
  • FVC, forced vital capacity
  • IMPACT-HF, initiation management predischarge process for assessment of carvedilol therapy for heart failure
  • MERIT-HF, metoprolol CR/XL randomised intervention trial in congestive heart failure
  • NYHA, New York Heart Association
  • OR, odds ratio
  • heart failure
  • β blockers
  • chronic obstructive pulmonary disease

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  • Published Online First 10 June 2005

  • No competing interests (all authors)