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

ed to the patients initiated post-discharge. Other important clinical events such as death or rehospitalizations were also less frequent at 60 days in the early treatment group, but because of small patient numbers and the short duration of follow-up did not reach statistical significance."

The safety issue is important, the researchers said, because until recently, initiation of beta-blockers was not recommended in patients with a recent episode of heart failure worsening. These new data should help encourage physicians to change long-held prescribing habits. The researchers said that many physicians, upon seeing their heart failure patients stabilized in-hospital, are hesitant to add another medication to the mix out of concern that patients' symptoms may worsen.

"We hope to change physicians' minds and get them to look at in-hospital beta-blocker use as a method to increase the overall use of beta-blockers in this population. Increased use of this evidence-based therapy will likely translate into improved outcomes for patients based on data from previous randomized trials," Gattis said.

O'Connor sees a similarity between the low rate of usage of beta-blockers for heart failure and another class of heart medications known as statins, which have been proven to lower cholesterol levels and, more importantly, to reduce the risk of death and myocardial infarction in patients with coronary heart disease.

"For a long time, the usage rate of statins was about 20 percent, even though clinical trials clearly demonstrated their effectiveness," O'Connor. "Then, later trials showed that it was not only safe to start statins in heart attack patients while still in the hospital, but that this early initiation of therapy led to a higher rate of use after discharge."

Heart failure often leaves patients exhausted and breathless, and the normal activities of these patients can be severely restricted. Although there is no cure for the disorder
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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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