The use of guideline recommended beta-blocker therapy in primary prevention implantable cardioverter defibrillator patients: Insight from Danish nationwide registers
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The use of guideline recommended beta-blocker therapy in primary prevention implantable cardioverter defibrillator patients : Insight from Danish nationwide registers. / Ruwald, Anne Christine; Gislason, Gunnar Hilmar; Vinther, Michael; Johansen, Jens Brock; Nielsen, Jens Cosedis; Petersen, Helen Høgh; Torp-Pedersen, Christian; Riahi, Sam; Jøns, Christian.
I: Europace, Bind 20, Nr. 2, 2018, s. 301-307.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - The use of guideline recommended beta-blocker therapy in primary prevention implantable cardioverter defibrillator patients
T2 - Insight from Danish nationwide registers
AU - Ruwald, Anne Christine
AU - Gislason, Gunnar Hilmar
AU - Vinther, Michael
AU - Johansen, Jens Brock
AU - Nielsen, Jens Cosedis
AU - Petersen, Helen Høgh
AU - Torp-Pedersen, Christian
AU - Riahi, Sam
AU - Jøns, Christian
PY - 2018
Y1 - 2018
N2 - Aims We aimed to examine the use of guideline recommended beta-blocker therapy prior to and after primary prevention implantable cardioverter defibrillator (ICD) implantation in a â real-life' setting. Methods and results From the Danish Pacemaker and ICD Registry we identified all 1st-time primary prevention ICD and cardiac resynchronization therapy defibrillator (CRT-D) implantations in Denmark from 2007-12 (n = 2935). Use of beta-blocker, type and dose was acquired through the Danish Prescription Registry. According to guideline recommendations, we defined target daily doses as ≥50 mg carvedilol and ≥200 mg metoprolol. Prior to implantation 2427 of 2935 (83%) patients received beta-blocker therapy, with 2166 patients (89%) having initiated treatment 3 months or more prior to implantation. The majority of patients was prescribed carvedilol (52%) or metoprolol (41%). Patients on carvedilol reached target dosages more frequently than patients on metoprolol, with 39% of patients on carvedilol and 26% of patients on metoprolol at the time of implantation (P < 0.001 for all time-points). Increase in proportion of patients reaching target daily doses was observed for both carvedilol and metoprolol after ICD implantation. Carvedilol treatment was a strong predictor for being on target dose of BB at time of implant, as was treatment with angiotensin-converting enzyme inhibitors and/or spironolactone, no history of myocardial infarction, younger age and less pronounced heart failure symptoms Conclusion In a real-life setting of primary prevention ICD patients, 39% and 26% of patients were titrated to optimal target dose of carvedilol or metoprolol prior to implantation. A higher proportion of patients on carvedilol reached target dose, as compared with metoprolol.
AB - Aims We aimed to examine the use of guideline recommended beta-blocker therapy prior to and after primary prevention implantable cardioverter defibrillator (ICD) implantation in a â real-life' setting. Methods and results From the Danish Pacemaker and ICD Registry we identified all 1st-time primary prevention ICD and cardiac resynchronization therapy defibrillator (CRT-D) implantations in Denmark from 2007-12 (n = 2935). Use of beta-blocker, type and dose was acquired through the Danish Prescription Registry. According to guideline recommendations, we defined target daily doses as ≥50 mg carvedilol and ≥200 mg metoprolol. Prior to implantation 2427 of 2935 (83%) patients received beta-blocker therapy, with 2166 patients (89%) having initiated treatment 3 months or more prior to implantation. The majority of patients was prescribed carvedilol (52%) or metoprolol (41%). Patients on carvedilol reached target dosages more frequently than patients on metoprolol, with 39% of patients on carvedilol and 26% of patients on metoprolol at the time of implantation (P < 0.001 for all time-points). Increase in proportion of patients reaching target daily doses was observed for both carvedilol and metoprolol after ICD implantation. Carvedilol treatment was a strong predictor for being on target dose of BB at time of implant, as was treatment with angiotensin-converting enzyme inhibitors and/or spironolactone, no history of myocardial infarction, younger age and less pronounced heart failure symptoms Conclusion In a real-life setting of primary prevention ICD patients, 39% and 26% of patients were titrated to optimal target dose of carvedilol or metoprolol prior to implantation. A higher proportion of patients on carvedilol reached target dose, as compared with metoprolol.
KW - Carvedilol
KW - Heart failure
KW - Metoprolol
KW - Predictors
KW - Target dose
KW - Treatment
U2 - 10.1093/europace/euw408
DO - 10.1093/europace/euw408
M3 - Journal article
C2 - 28339659
AN - SCOPUS:85041692314
VL - 20
SP - 301
EP - 307
JO - Europace
JF - Europace
SN - 1099-5129
IS - 2
ER -
ID: 213964266