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BB's are first line treatment for NYHA II-IV HF
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Gradual titration of dosing is important to prevent HF exacerbation and improve tolerability
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Fluid assessment is very important
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Titrate doses by 50-100% as tolerated every 2-4 weeks--individualize to the patient
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Avoid reducing diuretic doses (unless adverse effects i.e. dehydration) while up-titrating
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BB's may be considered in patients with recent HF exacerbations as long as they are stable and euvolemic
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Compliance is increased with once daily dosing
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Consider beta-selective agents in airway disease
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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:
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- Hypotension: nitrates, antihypertensive agents, hydralazine, diuretics
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- Bradycardia: digoxin, verapamil, diltiazem, amiodarone, dronedarone
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PATIENT COUNSELLING TIPS:
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- BB's may worsen HF symptoms initially (particularly fatigue), but in long run will improve symptoms
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- BB's are started at low dose, titrated slowly to minimize adverse effects
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- Self-monitoring for symptoms is key
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- 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
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- Stopping high dose BB's abruptly may result in a rapid HR and exacerbation of HF symptoms--titrate dose down when possible