082 Chronic obstructive pulmonary disease: the new deal for b-blocker prescription in chronic heart failure

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• 作者：Michel Galinier¹ ; Nacima Demil² ; Patrick Assyag³ ; Pascal De Groote⁴ ; Richard Isnard⁵ ; Guillaume Jondeau⁶ ; Alain Ducardonnet⁷ ; Jean-Fran&ccedil ; ois Thé ; baut⁸ ; Michel Komajda⁵
• 刊名：Archives of Cardiovascular Diseases Supplements
• 出版年：2010
• 出版时间：January 2010
• 年：2010
• 卷：2
• 期：1
• 页码：27-28
• 全文大小：90 K

文摘

Background

The recent European Guidelines for the treatment of CHF 2008 underlined that the majority of patient with CHF and COPD can safely tolerate ¦Â-blocker therapy.

Aims

The IMPACT-RECO program III analysed the impact of NYHA class and of comorbidities on therapeutic management of French outpatients with stable CHF and left ventricular ejection fraction (LVEF) < 40 % .

Methods

This survey was carried out from March 2007 to December 2007 among randomly selected French private cardiologists. 1574 patients with CHF and LVEF < 40 % were included. Key demographics including comorbidities such as asthma and COPD, as well as ongoing medical treatment of CHF were collected. Physicians were asked about reasons for not prescribing ¦Â-blockers.

Results

Mean age was 71 ¡À 11 years, 75 % of the patients were men, 34 % were in NYHA class III-IV, 54 % had coronary artery disease, 30 % atrial fibrillation and the mean LVEF was 34 ¡À 7 % . 78.3 % of the patients received a ¦Â-blocker, and asthma or BPCO were reported in 13.7 % . 341 patients were not receiving ¦Â-blockers. The first reason for non-prescription was presumed contra-indication in 51.9 % (177 pts). This contra-indication was asthma or COPD in 71 % , symptomatic hypotension in 15 % , bradycardia in 12 % and other problems in 8 % . The second reason for non prescribing ¦Â-blockers was previous side effects in 35.2 % (120 pts) including heart failure decompensation in 39 % , symptomatic hypotension in 36 % , asthenia in 26 % , bradycardia in 18 % , impotence in 5 % and others in 6 % . Lastly, in 10.9 % of patients without ¦Â-blockers, the reason for non prescription was fear of potential side effect.

Conclusion

Respiratory disease remains the main reason for not prescribing ¦Â-blockers in CHF despite the fact that selective ¦Â-blockers are now recommended in this population. Room remains for improvement in ¦Â-blockers prescription rate in CHF patients with concomitant COPD, underscoring the importance of pursuing education of cardiologists.