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Item #9
Huge
Mistake – Heart Failure Patients Not Being Treated With
Beta-blockers
This
is a HUGE problem...and often a HUGE mistake because Beta-blockers
increase survival by about 35%.
Millions
of patients are hospitalized for heart failure every year. Most of
them don't get a beta-blocker...due to concerns that it could worsen
cardiac output. This is a
HUGE problem...and often a HUGE mistake.
Beta-blockers increase survival by about 35%.
Most
heart failure patients should get a beta-blocker...but ONLY after
they're stabilized on a diuretic, ACE inhibitor, etc.
Suggest metoprolol or carvedilol...they're the only
beta-blockers approved for heart failure.
Metoprolol
extended-release (Toprol XL) selectively blocks the beta-1
receptor. It's often preferred for patients who have LOW blood
pressure or pulmonary disease. It
lowers blood pressure less than carvedilol...and is less likely to
exacerbate pulmonary conditions.
Carvedilol
(Coreg) blocks beta-1, beta-2, and alpha-1 receptors. It's
often preferred for patients with HIGH blood pressure.
Keep in mind that beta-blockers can worsen symptoms initially.
To minimize this, patients start on low doses...and increase
slowly. Takes 2 to 3 months to see improvement.
Even
if symptoms don't improve, encourage patients to continue using a
beta-blocker to prevent cardiac deterioration
Pharmacotherapy
2002;22:1036. Am J Health-Sys Pharm 2002;1340. Ann Pharmacother
2003;37:287. Am
J Med 2002;112:49. Am J Med 2000;109:523.
Lancet 2002;360:1375. New
Engl J Med 2002;347;1909,1962. BMJ
2002;325:1333. Mayo Clin
Proc 2002;77:1199,1206. JAMA 2002;287:890
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