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Starting beta-blocker before discharge in patients hospitalized for heart failure increases usage

CHICAGO -- Initiating low-dose beta-blockers prior to discharge in heart failure patients hospitalized for worsening symptoms significantly improves the use of a drug that has been shown in previous studies to reduce death and morbidity by more than 35 percent.

This finding is significant, said researchers from Duke University Medical Center and Northwestern University, because standard heart failure practice guidelines suggest waiting a period of two to four weeks after discharge prior to initiating beta-blocker therapy. This recommendation was based on a concern that beta-blocker initiation too soon after a hospitalization for heart failure may worsen heart failure symptoms, said the researchers.

Beta-blockers block the stimulatory effects of the neurohormones epinephrine and norepinephrine, the so-called "fight-or-flight" hormones. By blocking these hormones, beta-blockers reduce the stress on the heart and reverse myocardial remodeling. Most importantly, they have been shown to improve survival and reduce the need for hospitalization by 35 percent in several large-scale, prospective, randomized clinical trials. Despite these beneficial effects, it is estimated that nationally still only 30 to 40 percent of eligible patients receive beta-blocker therapy.

Such low usage led the researchers to initiate a trial to determine whether starting beta-blocker therapy in the hospital setting would improve usage. The results of that trial, reported today (Nov. 18, 2002) at the 75th annual scientific session of the American Heart Association, show that beginning beta-blocker therapy in-hospital can achieve a 91 percent usage rate 60 days after discharge.

"If we can dramatically improve the rate of beta-blocker usage by initiating therapy in-hospital, that would make a major impact these patients' lives," said Duke cardiologist Christopher O'Connor, M.D., who along with Duke's Wendy Gattis, Pharm.D., and Northwestern's Mihai Gheorghiade, M.D.,
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Contact: Richard Merritt
merri006@mc.duke.edu
919-684-4148
Duke University Medical Center
18-Nov-2002


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