The use of guideline recommended beta-blocker therapy in primary prevention implantable cardioverter defibrillator patients: insight from Danish nationwide registers

Anne Christine H Ruwald, Gunnar Hilmar Gislason, Michael Vinther, Jens Brock Johansen, Jens Cosedis Nielsen, Helen Hoegh Petersen, Christian Torp-Pedersen, Sam Riahi, Christian Jøns

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

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 '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.

Original languageEnglish
JournalEuropace
Volume20
Issue number2
Pages (from-to)301–307
ISSN1099-5129
DOIs
Publication statusPublished - 1. Feb 2018

Keywords

  • Journal Article
  • Heart failure
  • Metoprolol
  • Treatment
  • Carvedilol
  • Target dose
  • Predictors
  • Humans
  • Middle Aged
  • Practice Patterns, Physicians'/standards
  • Carbazoles/administration & dosage
  • Male
  • Female
  • Retrospective Studies
  • Adrenergic beta-Antagonists/administration & dosage
  • Primary Prevention/methods
  • Metoprolol/administration & dosage
  • Risk Factors
  • Treatment Outcome
  • Electric Countershock/adverse effects
  • Death, Sudden, Cardiac/prevention & control
  • Denmark
  • Guideline Adherence/standards
  • Aged
  • Propanolamines/administration & dosage
  • Defibrillators, Implantable/standards
  • Practice Guidelines as Topic

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