β-Blockade in Heart Failure With Reduced Ejection Fraction

Does Heart Rate Control Influence Readmissions?

Ryan E. Owens, Jennifer D. Twilla, Timothy H. Self, Abdulrahman I. Alshaya, Carlvin J. Metra, Carolyn Cummings, Carrie S. Oliphant

Research output: Contribution to journalArticle

Abstract

Background: Raised resting heart rate (HR), >70 beats per minute (bpm), has been shown to be a risk factor for adverse cardiovascular outcomes and hospital readmissions, specifically in patients with heart failure with reduced ejection fraction (HFrEF). Given their mortality benefit, β-blockers are recommended in HFrEF, with a goal to titrate to a maximum tolerated dose rather than a specific HR target. Objective: To determine the impact of optimal HR control achievement prior to hospital discharge on hospital readmissions in patients with HFrEF receiving β-blockade. Methods: A retrospective study of patients admitted to 5 adult hospitals within a large urban health-care system, between 2013 and 2015, was conducted. Patients were identified via International Classification of Diseases, Ninth Revision (ICD-9) coding for acute on chronic HFrEF. Results: Of the 225 patients included, 20% achieved optimal HR control (n = 46, HR <70 bpm; n = 179, HR ≥70 bpm) and only 15% received β-blocker titration during hospital admission. Of note, 25% of patients receiving ≥50% target dose (n = 79) and 28% receiving 100% target dose (n = 39) achieved optimal HR control. At 30 days, patients with an HR <70 bpm versus HR ≥70 bpm exhibited similar readmission rates (9% vs 11%, respectively; P >.99) and ED visits (11% vs 8%, respectively; P =.57). Conclusions: Readmission rates were similar among patients with HFrEF despite the majority failing to achieve optimal HR control from β-blockade. However, β-blocker dosing remains suboptimal relative to guideline-recommended target doses. Opportunities exist for inpatient clinicians to optimize β-blockade in an attempt to achieve HR control.

Original languageEnglish (US)
Pages (from-to)40-45
Number of pages6
JournalJournal of Pharmacy Practice
Volume31
Issue number1
DOIs
StatePublished - Feb 1 2018

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Heart Failure
Heart Rate
Patient Readmission
International Classification of Diseases
Urban Health
Maximum Tolerated Dose
Inpatients
Retrospective Studies
Guidelines
Delivery of Health Care
Mortality

All Science Journal Classification (ASJC) codes

  • Pharmacology (medical)

Cite this

Owens, R. E., Twilla, J. D., Self, T. H., Alshaya, A. I., Metra, C. J., Cummings, C., & Oliphant, C. S. (2018). β-Blockade in Heart Failure With Reduced Ejection Fraction: Does Heart Rate Control Influence Readmissions? Journal of Pharmacy Practice, 31(1), 40-45. https://doi.org/10.1177/0897190017696951

β-Blockade in Heart Failure With Reduced Ejection Fraction : Does Heart Rate Control Influence Readmissions? / Owens, Ryan E.; Twilla, Jennifer D.; Self, Timothy H.; Alshaya, Abdulrahman I.; Metra, Carlvin J.; Cummings, Carolyn; Oliphant, Carrie S.

In: Journal of Pharmacy Practice, Vol. 31, No. 1, 01.02.2018, p. 40-45.

Research output: Contribution to journalArticle

Owens, RE, Twilla, JD, Self, TH, Alshaya, AI, Metra, CJ, Cummings, C & Oliphant, CS 2018, 'β-Blockade in Heart Failure With Reduced Ejection Fraction: Does Heart Rate Control Influence Readmissions?', Journal of Pharmacy Practice, vol. 31, no. 1, pp. 40-45. https://doi.org/10.1177/0897190017696951
Owens, Ryan E. ; Twilla, Jennifer D. ; Self, Timothy H. ; Alshaya, Abdulrahman I. ; Metra, Carlvin J. ; Cummings, Carolyn ; Oliphant, Carrie S. / β-Blockade in Heart Failure With Reduced Ejection Fraction : Does Heart Rate Control Influence Readmissions?. In: Journal of Pharmacy Practice. 2018 ; Vol. 31, No. 1. pp. 40-45.
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