[Show abstract][Hide abstract] ABSTRACT: Background: In heart failure, the Left ventricular ejection fraction (LVEF) is decreased. Ejection fraction is expressed as a percentage and normal value is between 50-70%. A prescription of a beta-blocker to advanced heart failure patient is said to be associated with an increase in LVEF.
Objective: To assess the impact of beta-blockers as adjuncts in the treatment therapy of advanced heart failure patients on the Left Ventricular Ejection Fraction.
Methods: The design was a prospective cohort study involving 583 New York Heart Association functional classes III and IV heart failure patients admitted at the medical wards of the hospital from 1st January 2010 to 30th September 2011. The patients were assigned to receive either Oral Carvedilol or Oral Bisoprolol or Control.
Results: There was a significant increase in the LVEF after treatment with carvedilol or bisoprolol as compared to control, differences in LVEF among the carvedilol and bisoprolol groups did not reach any statistical significance p=0.06. The crude mortality of patients with LVEF 15% was 10% higher than that of patients with an LVEF of 16% to 25%. Deaths due to arrhythmias, worsening Heart Failure and other cardiac causes were more frequent among patients in lower LVEF groups (p < 0.0001). Deaths due to non-cardiovascular causes were more frequent among patients with LVEF > 45% (p = 0.046).
Conclusion: The study shown that significant increase in the LVEF occurred after treatment with beta-blockers, differences among the two beta-blockers were small and probably clinically insignificant.
[Show abstract][Hide abstract] ABSTRACT: Charles Anane1, Prof Emeritus Kwame Sarpong2, Dr Kwame Ohene-Buabeng2, Dr Isaac Kofi Owusu1,3
1 Clinical Pharmacy, Komfo Anokye Teaching Hospital, Ghana
2 Clinical And Social Pharmacy, Kwame Nkrumah University of Science and Technology, Ghana
3 Medicine, Cardiology, Kwame Nkrumah University of Science and Technology, Ghana
Background: The quality of life and physical condition of advanced heart failure patients are severely compromised by the symptoms of the disease. The instruments used to assess quality of life are specially designed questionnaires.
Objective: To assess the impact of β-blockers as adjuncts on the quality of life of patients with advanced heart failure using two standard quality of life questionnaires.
Design: Cohort study involved patients with advanced heart failure. Patients enrolled had Left Ventricular Ejection Fraction of ≤30% and were 30 years or above in age. The quality of life of the study patients was assessed using Minnesota living with heart failure (MLhf) and Left Ventricular Dysfunction 36(LVd36) questionnaires on admission and 6-month after discharged to the Cardiac Clinic.
Patients: 583 patients with mean age 62 years ±14.5 SD (95% CI, 60.8-63.2), 51% females and 49% males. The patients were non-randomly assigned to Carvedilol (35.7%), Bisoprolol (40.1%) and Placebo (24.2%). Improvement of quality of life measured with MLhf and LVd36 questionnaires.
Results: Mortality rate after 6 months of therapy was 10.6% in the Carvedilol group, 11.5% in the Bisoprolol group and 25.5% in the Placebo group. MLhf Questionnaire score was 72.3±10.8 at baseline and 41.8±14.0 after 6 months. LVd36 score was 70.1±9.1 and 25.6±12.8 after 6 months. Placebo group scored 72.1±10.9 and 54.9±10.0 after 6 months and LVd36 score was 70.2±8.2 and 40.6±14.8 after 6 months (p˂0.001).
Conclusion: Patients treated with carvedilol and bisoprolol were associated with better quality of life than placebo group.
[Show abstract][Hide abstract] ABSTRACT: Background: Advanced heart failure is characterized by frequent hospital admissions and prolonged length of hospital stay. Meta analysis of clinical trials has shown that low left ventricular ejection fraction, severe renal impairment or diabetes mellitus are associated with longer hospital stay.
Objective: To determine factors that influence the length of stay of advanced heart failure patients.
Design: Cohort study involved 583 patients with advanced heart failure. Patients enrolled had Left Ventricular Ejection Fraction of ≤30% and were 30 years or above in age. The patients’ length of stay at the hospital was determined by counting the days from admission till discharge.
Patients: The patients had a mean age 62 years ±14.5 SD (95% CI, 60.8-63.2), 51% females and 49% males. The patients were assigned to Carvedilol, Bisoprolol and Control.
Results: The mean length of hospital stay was 7.7 days ±2.9 (CI 7.6-8.0) with a minimum stay of 2 days and maximum stay of 19 days. More than 64.3% of the cohort stayed in the hospital for more than 7 days or longer. There was no difference in the length of hospital stay between patients admitted with advanced heart failure for the first time and those with one or more previous admissions and the 3 interventional groups.
Conclusion: Longer length of stay, defined as >6 days was associated with the presence of peripheral congestion requiring treatment with intravenous diuretic, concomitant acute medical conditions like chronic kidney disease, stroke, diabetes mellitus and chronic anaemia. The fact that more than 52.5% of the patients in the study were in unstable and critical condition on admission contributed to longer days of hospital stay.
No preview · Article · Jun 2012 · The American Journal of Cardiology