RAFT: Beta Blocker Therapy in Congestive Heart Failure Patients With LVEF

Use of beta blocker therapy to treat congestive heart failure (CHF) patients with reduced left ventricular ejection fraction (LVEF) remains paramount, with benefits independent of those of newer CHF therapies, according to results of the RAFT Study presented on Sept. 2 during the ESC Congress 2013.

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The study, based on 1,474 patients (83% male, mean age 66.1 ± 9.4 yrs, mean LVEF 22.6 ± 5.1), compared the rates of death or CHF hospitalization in patients receiving ≤50% of target doses of either metoprolol (M), carvedilol (C), or bisoprolol (B) to those receiving larger doses.

Overall, the study found beta blocker use at < 50% of target dosage to be one of the strongest predictors of death or hospitalization. After 2,000 days, the probability of death or hospitalization was 0.58 for patients on ≤50% of target beta blocker dose versus 0.43 for those on higher dosages (p<0.0001)." There were no differences in outcomes based on the specific beta blocker used.

"The benefits of beta blocker therapy in this setting are dose-dependent emphasizing the need to optimize beta blocker dose in patients with advanced CHF with or without CRT," the authors said.

According to the study authors, other independent predictors of death or hospitalization included previous CABG, ischemic heart disease, peripheral vascular disease, impaired renal function or use of an ICD without cardiac resynchronization therapy (CRT). They noted in their findings that the superiority of higher beta-blocker dosages are less evident in CRT-ICD patients than in ICD patients.

Clinical Topics: Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Vascular Medicine, Implantable Devices, Statins, Acute Heart Failure

Keywords: Myocardial Ischemia, Carbazoles, Heart Failure, Stroke Volume, Propanolamines, Probability, Hospitalization, Peripheral Vascular Diseases, Cardiac Resynchronization Therapy

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