scholarly journals Effect of Beta-Blocker Therapy, Maximal Heart Rate, and Exercise Capacity During Stress Testing on Long-Term Survival (from The Henry Ford Exercise Testing Project)

2016 ◽  
Vol 118 (11) ◽  
pp. 1751-1757 ◽  
Author(s):  
Rupert K. Hung ◽  
Mouaz H. Al-Mallah ◽  
Seamus P. Whelton ◽  
Erin D. Michos ◽  
Roger S. Blumenthal ◽  
...  
Keyword(s):  
Heart Rate ◽  
Exercise Capacity ◽  
Exercise Testing ◽  
Beta Blocker ◽  
Stress Testing ◽  
Maximal Heart Rate ◽  
Term Survival ◽  
Blocker Therapy ◽  
Henry Ford

Abstract MP78: Effect of Beta-Blocker Therapy, Maximal Heart Rate and Exercise Capacity During Stress Testing on Long-Term Survival

Circulation ◽  
2015 ◽  
Vol 131 (suppl_1) ◽  
Author(s):  
Rupert K Hung ◽  
Mouaz Al-Mallah ◽  
Seamus P Whelton ◽  
Roger S Blumenthal ◽  
Clinton A Brawner ◽  
...  
Keyword(s):  
Heart Rate ◽  
Exercise Capacity ◽  
Beta Blocker ◽  
Prognostic Value ◽  
Stress Testing ◽  
Maximal Heart Rate ◽  
Blocker Therapy ◽  
Beta Blocker Therapy ◽  
Long Term Mortality

Background: Whether beta-blocker therapy (BBT) attenuates the prognostic value of percentage-predicted maximal heart rate (ppMHR) achieved during stress testing remains unclear. The combined effect of ppMHR and exercise capacity on long-term mortality is unknown. Methods: We analyzed 67,772 adults (54 ± 13 years old, 54% men (36,639 of 67,772), 29% black (19,834 of 67,772)) from The FIT Project, a retrospective cohort study of patients who underwent physician-referred exercise stress testing at a single healthcare system between 1991 and 2009. Patients were categorized by baseline use of BBT. Maximal age-predicted heart rate was defined as 220-age. We derived adjusted mortality rates over the range of ppMHR using margins of response logistic regression models. Our primary model included adjustment for demographic data, resting blood pressures, medical history, pertinent medications, and indication for stress testing. Our secondary model included further adjustment for exercise capacity. Results: There were 10,594 deaths over 11 ± 5 years of follow-up. Patients on BBT tended to have more comorbidities and other medication use (P<.001). After accounting for differences between BBT groups, BBT was associated with an 8% lower ppMHR (83% in BBT vs. 91% in no BBT) in both men and women. ppMHR was inversely associated with all-cause mortality in both analyses performed (P≤.001), though the association was significantly attenuated by BBT (P=.03) [Panel A]. Exercise capacity further attenuated the prognostic value of ppMHR in all patients, particularly in those on BBT, and reduced the difference in risk between those on BBT and not on BBT (P=.08) [Panel B]. Conclusion: BBT attenuated the association between ppMHR achieved during stress testing and long-term mortality. Exercise capacity further attenuated the prognostic significance of ppMHR, particularly in patients on BBT.

Relation of Resting Heart Rate to Risk for All-Cause Mortality by Gender After considering Exercise Capacity (the Henry Ford Exercise Testing Project)

2014 ◽  
Vol 114 (11) ◽  
pp. 1701-1706 ◽  
Author(s):  
Amer I. Aladin ◽  
Seamus P. Whelton ◽  
Mouaz H. Al-Mallah ◽  
Michael J. Blaha ◽  
Steven J. Keteyian ◽  
...  
Keyword(s):  
Heart Rate ◽  
Exercise Capacity ◽  
Exercise Testing ◽  
Resting Heart Rate ◽  
All Cause Mortality ◽  
Henry Ford

scholarly journals The Relationship Between Severe Complications, Beta-Blocker Therapy and Long-Term Survival Following Emergency Surgery for Colon Cancer

2019 ◽  
Vol 43 (10) ◽  
pp. 2527-2535 ◽  
Author(s):  
Rebecka Ahl ◽  
Peter Matthiessen ◽  
Yang Cao ◽  
Gabriel Sjolin ◽  
Olle Ljungqvist ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Beta Blocker ◽  
Emergency Surgery ◽  
Term Survival ◽  
Blocker Therapy ◽  
Long Term Survival ◽  
Beta Blocker Therapy ◽  
The Relationship

P1245In a prospective randomized study in familial hypertrophic cardiomyopathy, metoprolol maintains exercise-performance, with lower myocardial oxygen-cost, and prevents deterioration in exercise-ability

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
I Ostman-Smith ◽  
E.-L Bratt ◽  
P Allahyari ◽  
M Petersson
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Beta Blocker ◽  
Exercise Performance ◽  
Myocardial Oxygen Consumption ◽  
Work Capacity ◽  
Maximal Heart Rate ◽  
Blocker Therapy ◽  
Beta Blocker Therapy

Abstract Background Hypertrophic cardiomyopathy (HCM) is an inherited disorder with a prevalence of 0.2% in young adults, with a significant risk of sudden death. Another feature of the disease is progressive fibrosis causing late heart failure. International guidelines suggest beta-blocker therapy for symptomatic patients, but that symptom-free patients need not be treated. Cohort studies on pediatric HCM-patients have suggested that beta-blocker therapy has a dose-related protective effect on the risk for sudden death, suggesting prophylactic beta-blocker therapy might benefit symptom-free patients. Purpose As prophylactic beta-blocker therapy is presumed to have a negative effect on exercise-ability, we assessed the effect of selective beta-blocker therapy on exercise hemodynamics and exercise performance in asymptomatic HCM patients. Methods Previously un-diagnosed cases of HCM were identified by family screening; those without symptoms and risk-factors were randomized to either life-style advice only (Obs-group; n=15), or to advice plus metoprolol therapy (Bbl-group; n=12). Patients performed bicycle ergometer testing before randomization, and yearly during follow-up. Performance in Watt was related to predicted normal for age, body size and sex; heart rate and blood pressure was recorded every minute during exercise terminated by patient tolerance. Results Median age was 18 [IQR 14–26]yrs, with a median follow-up of 6.0 [2.0–8.0]yrs. In the Obs-group the exercise-ability had deteriorated after two years (median 80% predicted vs. initial 88%, p=0.021), and remained lower at last follow-up, 78% (p=0.0017). Patients in the Bbl-group received a median final dose of 325mg metoprolol/day, corresponding to 3.8 [3.5–4.3]mg/kg, and had a reduction in maximal heart rate, 134 vs. 182 bpm (p=0.ehz748.02033], and systolic blood pressure 164 vs. 182 mmHg (p=0.0077), at maximal work load compared to Obs-group. In spite of reduction in maximal heart rate there was no reduction in maximal work capacity in Bbl-group (p=0.33 two year, p=0.50 last follow-up), with within patient change 2% of predicted [−3 to +5]% vs. −6% [−14 to −3]% in Obs-group (p=0.0039). Last visit work capacity was 180 [170–190]Watt in Obs-group and 205 [185–210]Watt in Bbl-group (p=0.015). Rate-pressure product (RPP) was 29% lower, and Watt/RPP was improved by 42% in Bbl-group compared to Obs-group (0.0084 vs. 0.0059; p=0.ehz748.02032). Conclusions Untreated patients with asymptomatic HCM show a slow deterioration in exercise-ability over follow-up, whereas patients treated with metoprolol do not decrease exercise performance compared with pre-treatment values, and do not deteriorate on medium-term follow-up. As myocardial oxygen consumption is linearly related to RPP, Bbl-group achieves a good exercise performance with substantially lower myocardial oxygen consumption than the Obs-group, which may have relevance for subendocardial ischaemia on exercise and future development of myocardial fibrosis. Acknowledgement/Funding Swedish Heart-Lung Fundation grant nr 20080510, Gothenburg University ALF grant nr ALFgbg-544981

P3517Failure to achieve adequate heart rate control in women during therapy optimization

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
V Kutyifa ◽  
J W Erath ◽  
A Burch ◽  
B Assmus ◽  
D Bondermann ◽  
...  
Keyword(s):  
Heart Failure ◽  
Heart Rate ◽  
Beta Blocker ◽  
Rate Control ◽  
Beta Blockers ◽  
Heart Rate Control ◽  
Blocker Therapy ◽  
Cardioverter Defibrillator ◽  
Beta Blocker Therapy ◽  
The Mean

Abstract Background Previous studies highlighted the importance of adequate heart rate control in heart failure patients, and suggested under-treatment with beta-blockers especially in women. However, data on women achieving effective heart rate control during beta-blocker therapy optimization are lacking. Methods The wearable cardioverter defibrillator (WCD) allows continuous monitoring of heart rate (HR) trends during WCD use. In the current study, we assessed resting HR trends (nighttime: midnight-7am) in women, both at the beginning of WCD use and at the end of WCD use to assess the adequacy of beta-blockade following a typical 3 months of therapy optimization with beta-blockers. An adequate heart rate control was defined as having a nighttime HR <70 bpm at the end of the 3 months. Results There were a total of 21,453 women with at least 30 days of WCD use (>140 hours WCD use on the first and last week). The mean age was 67 years (IQR 58–75). The mean nighttime heart rate was 72 bpm (IQR 65–81) at the beginning of WCD use, that decreased to 68 bpm (IQR 61–76) at the end of WCD use with therapy optimization. Women had an insufficient heart rate control with resting heart rate ≥70 bpm in 59% at the beginning of WCD use that decreased to 44% at the end of WCD use, but still remained surprisingly high. Interestingly, there were 21% of the women starting with HR ≥70 bpm at the beginning of use (BOU) who achieved adequate heart rate control by the end of use (EOU). Interestingly, 6% of women with adequate heart rate control at the start of therapy optimization ended up having higher heart rates >70 bpm at the end of the therapy optimization time period (Figure). Figure 1 Conclusions A significant proportion of women with heart failure and low ejection fraction do not reach an adequate heart rate control during the time of beta blocker initiation/titration. The wearble cardioverter defibrillator is a monitoring device that has been demonstrated in this study to appropriately identify patients with inadequate heart rate control at the end of the therapy optimization period. The WCD could be utilized to improve management of beta-blocker therapy in women and improve the achievement of adequate heart rate control in women.

Abstract 129: Effects of Pulse Pressure and Antihypertensive Therapy on Short and Long Term Outcomes in Stroke Patients

Hypertension ◽  
2012 ◽  
Vol 60 (suppl_1) ◽  
Author(s):  
Avinash Murthy ◽  
Jaspreet Arora ◽  
Amar Shah ◽  
Hussain Khawaja ◽  
Mikhail Torosoff
Keyword(s):  
Beta Blocker ◽  
Pulse Pressure ◽  
Beta Blockers ◽  
Long Term Outcomes ◽  
Blocker Therapy ◽  
Hospital Deaths ◽  
Long Term Survivors ◽  
Hypertensive Therapy ◽  
Long Term Mortality

Background: Effects of pulse pressure and benefits of blood pressure lowering with intravenous anti-hypertensive medications and beta-blockers in CVA patients have not been well investigated. Material and Methods: Demographic, clinical, and echocardiographic data were collected and long-term outcomes (55+/-21 months) were ascertained in 356 consecutive cerebro-vascular accident (CVA) patients. ANOVA, chi-square, Kaplan-Meier, and logistic regression tests were employed. Study was approved by the institutional IRB. Results: Widened pulse pressure on admission was significantly elevated in CVA patients who expired in the hospital or during the long-term follow-up (62+/-21mmHg for long-term survivors vs. 72+/-20mmHg for hospital deaths vs. 69+/-28 mmHg for long-term deaths, p=0.01). There was a trend towards increased hospital mortality (14% in long-term survivors vs. 25% in hospital deaths vs. 22% in long-term deaths, p=0.110) in CVA patients requiring IV anti-hypertensive therapy. Utilization of beta-blockers was lower in patients who suffered hospital death, but more likely in patients experiencing long-term death (42% use in hospital deaths vs. 48% in long-term survivors vs. vs. 66% in long-term deaths, p=0.003). Beta-blocker use was not predictive of hospital outcomes but was strongly predictive of adverse event long-term events (HR 2.1, 95%CI 1.3-3.4, p=0.002). When adjusted for demographic parameters and co-morbidities in multivariate analysis, pulse pressure and IV anti-hypertensive therapy were not predictive of short or long-term outcomes, while beta-blocker treatment was associated with reduced hospital (0.3, 95%CI 0.1-0.9, p=0.029) but not long-term mortality. Conclusions: Widened pulse pressure and need for IV anti-hypertensive therapy are not predictive of adverse short- or long-term outcomes when demographics and co-morbidities are accounted for. Effects of beta-blocker therapy on outcomes in CVA patients are complex. Wider beta-blocker use in acute CVA may be associated with better hospital outcomes, while increased long term mortality with beta-blocker therapy may be indicative of poor cardiovascular health leading to adverse outcomes

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