Effect of β-Blocker Cessation on Chronotropic Incompetence and Exercise Tolerance in Patients With Advanced Heart Failure
Why the study?
Does acute beta-blocker cessation improve chronotropic incompetence and exercise tolerance in patients with advanced heart failure?
Population
19 patients with systolic heart failure receiving long-term beta-blocker therapy, mean age 49.4±12.3 years.
Comparison
Cardiopulmonary exercise tolerance testing after… vs Cardiopulmonary exercise tolerance testing 3…
Design
RCT, random sequence
Follow-up
acute (27-hour washout vs 3 hours post-ingestion)
Authors
Discussion
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Member takes
Implication
Acute β-blocker cessation modestly augments peak HR and VO2 in advanced HF; confirms chronotropic incompetence is not solely β-blockade-mediated.
Structured PICO
Does acute beta-blocker cessation improve chronotropic incompetence and exercise tolerance in patients with advanced heart failure?
P
Population
19 patients with systolic heart failure (LVEF 22.8±7.7%) receiving long-term beta-blocker therapy, mean age 49.4±12.3 years.
I
Intervention
Cardiopulmonary exercise tolerance testing after a 27-hour beta-blocker washout period (Off-BB)
C
Comparator
Cardiopulmonary exercise tolerance testing 3 hours after beta-blocker ingestion (On-BB)
O
Outcome
Chronotropic response to exercise (peak HR as % HR reserve and % maximally predicted HR) and peak oxygen consumptionsurrogate
Acute beta-blocker cessation does not normalize the chronotropic response to exercise in patients with advanced heart failure and chronotropic incompetence, suggesting the impairment is not solely attributable to beta-blockade.
Cite This Study
Hirsh et al. (2012) studied this question.