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blood pressure, cardiovascular nursing, chronic heart failure, heart rate, [beta]-blockers



  1. McGinlay, Melanie RN
  2. Straw, Sam MBChB
  3. Byrom-Goulthorp, Rowenna RN
  4. Relton, Samuel D. PhD
  5. Gierula, John PhD
  6. Cubbon, Richard M. PhD
  7. Kearney, Mark T. MD
  8. Witte, Klaus K. MD


Background: The evidence base for the benefits of [beta]-blockers in heart failure with reduced ejection fraction (HFrEF) suggests that higher doses are associated with better outcomes.


Objectives: The aim of this study was to report the proportion of patients receiving optimized doses of [beta]-blockers, outcomes, and factors associated with suboptimal dosing.


Methods: This was a prospective cohort study of 390 patients with HFrEF undergoing clinical and echocardiography assessment at baseline and at 1 year.


Results: Two hundred thirty-seven patients (61%) were receiving optimized doses (>=5-mg/d bisoprolol equivalent), 72 (18%) could not be up-titrated (because of heart rate < 60 beats/min or systolic blood pressure <100 mm Hg), and the remaining 81 (21%) should have been. Survival was similarly reduced in those who could not and should have been receiving 5 mg/d or greater, and patient factors did not explain the failure to attain optimized dosing.


Conclusions: Many patients with HFrEF are not receiving optimal dosing of [beta]-blockers, and in around half, there was no clear contraindication in terms of heart rate or blood pressure.