BETA-BLOCKERS PEARLS
  • BB's are first line treatment for NYHA II-IV HF
  • Gradual titration of dosing is important to prevent HF exacerbation and improve tolerability
  • Fluid assessment is very important
  • Titrate doses by 50-100% as tolerated every 2-4 weeks--individualize to the patient
  • Avoid reducing diuretic doses (unless adverse effects i.e. dehydration) while up-titrating
  • BB's may be considered in patients with recent HF exacerbations as long as they are stable and euvolemic
  • Compliance is increased with once daily dosing
  • Consider beta-selective agents in airway disease
  • Given that the main side effects of BB's are hypotension and bradycardia, elimination of other non-mortality/morbidity reducing medications that precipitate these effects is warranted:
    • - Hypotension: nitrates, antihypertensive agents, hydralazine, diuretics
    • - Bradycardia: digoxin, verapamil, diltiazem, amiodarone, dronedarone
  • PATIENT COUNSELLING TIPS:
    • - BB's may worsen HF symptoms initially (particularly fatigue), but in long run will improve symptoms
    • - BB's are started at low dose, titrated slowly to minimize adverse effects
    • - Self-monitoring for symptoms is key
    • - Daily weights are important; call your health care provider if your weight increases by 2-3lbs in 1-2 days or 5lbs in 1 week
    • - Stopping high dose BB's abruptly may result in a rapid HR and exacerbation of HF symptoms--titrate dose down when possible