established beta Adrenergic Receptor Blocking therapy and acute myocardial infarction a clinical study of risks and benefits

. In order to evaluate the risks and benefits of continuing established therapy with β-Adrenergic Receptor Blocking drugs during acute myocardial infarction (AMI), 183 consecutive patients, 63 with (β-blocker group) and 120 without (control group) this therapy, were studied. Detailed information on previous diseases, present symptoms, established medication, clinical and laboratory findings on admission and during the first 12 hours in the CCU was collected. The incidences of congestive heart failure, hypotension, AV blocks and ventricular arrhythmias were not significantly different in the two groups. The incidence of anterior wall infarction was the same in both groups (38%) but inferior wall infarction was significantly more common in the control group (8 vs. 28%, p<0.01). Thus, continuation of established therapy with β-Adrenergic Receptor Blocking drugs does not seem to increase the risk of complications after hospital admission for AMI. The reason for the low incidence of inferior wall infarction in the β-blocker group is not clear but it cannot be excluded that when patients on β-Adrenergic Receptor Blocking therapy develop an inferior AMI, they may run a greater risk of sudden death.

Established Beta-Adrenergic Receptor Blocking Therapy and Acute Myocardial Infarction: A Clinical Study of Risks and Benefits

. In order to evaluate the risks and benefits of continuing established therapy with β-Adrenergic Receptor Blocking drugs during acute myocardial infarction (AMI), 183 consecutive patients, 63 with (β-blocker group) and 120 without (control group) this therapy, were studied. Detailed information on previous diseases, present symptoms, established medication, clinical and laboratory findings on admission and during the first 12 hours in the CCU was collected. The incidences of congestive heart failure, hypotension, AV blocks and ventricular arrhythmias were not significantly different in the two groups. The incidence of anterior wall infarction was the same in both groups (38%) but inferior wall infarction was significantly more common in the control group (8 vs. 28%, p

combined therapy with ca antagonists and beta Adrenergic Receptor Blocking agents in chronic stable angina

Summary

There have been conflicting reports on the safety of combining betaAdrenergic Receptor blockers and Ca++ -antagonists, especially verapamil, in the treatment of cardiovascular diseases. Warnings have been raised against additive negative chronotropic and inotropic effects. This study was designed to compare the efficacy and safety of simultaneous administration of verapamil, 360 mg daily, and atenolol, 100 mg daily, with that of either drug alone. Eighteen patients (mean age 58 years) with chronic stable angina were included in the study. After a two-week run-in period, the patients received either drug alone for six weeks and were then given the combination for another six weeks. Frequent ECG and blood pressure measurements were performed. Radionuclide evaluation of left ventricular ejection fraction was done before and at the end of the combined therapy. Exercise testing using a bicycle ergometer was performed during each treatment period.

Only one patient developed sinus bradycardia when on combined therapy (48 bpm). The P-Q time increased with single drug therapy as well as with the combination (p < 0.01). Maximal exercise time increased more with the combination than with single drug therapy. No serious adverse hemodynamic effects were recorded. LVEF increased by 4.6% (p < 0.01) with the combined therapy. A decrease in nitroglycerine consumption occurred, beeing most pronounced with the combined therapy and corresponding to a subjective improvement. It is concluded that an additive negative chronotropism occured but that the combination is safe and offers an effective therapeutic alternative in chronic stable angina.

A nurse-led up-titration clinic improves chronic heart failure optimization of beta-Adrenergic Receptor Blocking therapy–a randomized controlled trial.

Beta-Adrenergic blockade has been shown to improve left ventricular function, reduce hospital admissions and improve survival in chronic heart failure with reduced ejection fraction (HFrEF), with mortality reduction starting early after beta-Adrenergic Receptor blocker initiation and being dose-related. The aim of this pilot study was to determine the effectiveness of a nurse-led titration clinic in improving the time required for patients to reach optimal doses of the beta-Adrenergic Receptor Blocking agents. We conducted a prospective pilot randomized controlled trial. Twenty eight patients with CHF were randomized to optimisation of beta-Adrenergic Receptor blocker therapy over six months by either a nurse-led titration (NLT) clinic, led by a nurse specialist with the support of a cardiologist in a CHF clinic, or by their primary care physician (usual care (UC)). The primary endpoint was time to maximal beta-Adrenergic Receptor blocker dose. The secondary end-point was the proportion of patients reaching the target dose of beta-Adrenergic Receptor blocker by six months. The patients were predominantly men (72%), age 67 ± 16 years; New York Heart Association (NYHA) functional class I (32%), II (44%) and III (20%); baseline left ventricular ejection fraction 33 ± 10%, and a low mean Charlson co-morbidity score of 2.5 ± 1.4. The time to maximum dose was shorter in the NLT group compared to the UC group (90 ± 14 vs 166 ± 8 days, p 

a nurse led up titration clinic improves chronic heart failure optimization of beta Adrenergic Receptor Blocking therapy a randomized controlled trial

Beta-Adrenergic blockade has been shown to improve left ventricular function, reduce hospital admissions and improve survival in chronic heart failure with reduced ejection fraction (HFrEF), with mortality reduction starting early after beta-Adrenergic Receptor blocker initiation and being dose-related. The aim of this pilot study was to determine the effectiveness of a nurse-led titration clinic in improving the time required for patients to reach optimal doses of the beta-Adrenergic Receptor Blocking agents. We conducted a prospective pilot randomized controlled trial. Twenty eight patients with CHF were randomized to optimisation of beta-Adrenergic Receptor blocker therapy over six months by either a nurse-led titration (NLT) clinic, led by a nurse specialist with the support of a cardiologist in a CHF clinic, or by their primary care physician (usual care (UC)). The primary endpoint was time to maximal beta-Adrenergic Receptor blocker dose. The secondary end-point was the proportion of patients reaching the target dose of beta-Adrenergic Receptor blocker by six months. The patients were predominantly men (72%), age 67 ± 16 years; New York Heart Association (NYHA) functional class I (32%), II (44%) and III (20%); baseline left ventricular ejection fraction 33 ± 10%, and a low mean Charlson co-morbidity score of 2.5 ± 1.4. The time to maximum dose was shorter in the NLT group compared to the UC group (90 ± 14 vs 166 ± 8 days, p < 0.0005). At six months, in the NLT group there were nine patients (82%) on high dose and one patient (9%) on low dose beta-Adrenergic Receptor blocker compared to the UC group with five (42%) patients reaching maximum dose and five (42%) patients on low dose (p = 0.04). The patients allocated to the NLT group also had significantly less worsening of depression between baseline and six months (p = 0.006). A NLT clinic improves optimisation of beta-Adrenergic Receptor blocker therapy through increasing the proportion of patients reaching maximal dose and facilitating rapid up-titration of beta-Adrenergic Receptor blocker agents in patients with chronic HFrEF. Australian Clinical Trials Registry (
ACTRN012606000383561
).