Treatment with beta-blockers in nurse-led heart failure clinics: titration efficacy and predictors of failure

BACKGROUND: Beta-blockers (BBs) are a cornerstone in the treatment of chronic heart failure (HF), but several surveys have documented that many patients are not offered treatment or are not titrated to target doses. In part to address this problem, specialized, nurse-led HF clinics have been initiated in many countries. However, little information is available to describe if such programs are successful in initiating and up-titrating BBs in daily clinical practice.

AIMS: To assess the proportion of patients with HF due to left ventricular systolic dysfunction on BB treatment three months after referral to a nurse-led HF clinic, and to identify baseline predictors of treatment failure.

METHODS: Consecutive records from 14 Danish nurse-led HF clinics were used.

RESULTS: 1533 patients met inclusion criteria. Mean age was 68.7 years and 72% were men. Three months after the initial HF clinic visit 63% of the patients were being treated with a BB. Mean dose (relative to target dose) was 63 (+/-35)% in patients receiving a BB and target dose was reached by 21%. Patients who were not on BBs were more often female, elderly and in NYHA class III-IV. In a multivariable model only lower age predicted BB use at three months (P<0.05). Younger age (P<0.001) and higher systolic blood pressure (P<0.001) were associated with higher doses of BB.

CONCLUSION: BB up-titration continues to be a challenge even in specialized clinics dedicated to this task. Elderly patients appear to be less likely to receive treatment.