ABSTRACT
Background: Beta-blockers have been shown to decrease mortality and morbidity in heart failure with reduced ejection fraction (HFrEF) patients. However, the side effects are also dose-related, leading to the underdosing. Cost constraint may be one of the limitations of appropriate beta-blocker use; this can be improved with generic drugs. However, the effects in real life practice have not been investigated. Methods and results: This study aimed to compare the efficacy and safety of generic and brand beta-blockers in HFrEF patients. We performed a retrospective cohort analysis in HFrEF patients who received either generic or brand beta-blocker in Chiang Mai Heart Failure Clinic. The primary endpoint was the proportion of patients who received at least 50% target dose of beta-blocker between generic and brand beta-blockers. Adverse events were secondary endpoints. 217 patients (119 and 98 patients received generic and brand beta-blocker, respectively) were enrolled. There were no differences between groups regarding age, gender, etiology of heart failure, New York Heart Association (NYHA) functional class, left ventricular ejection fraction (LVEF), rate of receiving angiotensin converting enzyme inhibitor (ACEI), angiotensin recepter blocker (ARB), or spironolactone. Patients receiving brand beta-blockers had lower resting heart rate at baseline (74.9 and 84.2 bpm, p = .001). Rate of achieved 50% target dose and target daily dose did not differ between groups (40.4 versus 44.5% and 48.0 versus 55.0%, p > .05, respectively). Rate of side effects was not different between groups (32.3 versus 29.5%, p > .05) and the most common side effect was hypotension. Conclusion: This study demonstrated that beta-blocker tolerability was comparable between brand and generic formulations. Generic or brand beta-blockers should be prescribed to HFrEF patients who have no contraindications.
ABSTRACT
BACKGROUND: Previous studies have shown that intraventricular conduction defect is associated with increased mortality in heart failure (HF) population. However, it is conflicting whether left bundle branch block (LBBB) or right bundle branch block (RBBB) is a better predictor for mortality. OBJECTIVE: To evaluate the relationship between patterns of bundle branch block (BBB) and all-cause mortality in Thai patients with chronic heart failure with reduced ejection fraction (HFrEF) and to compare the prognostic values of RBBB and LBBB in this population. MATERIAL AND METHOD: The authors retrospectively studied a cohort of 170 patients (age 58 +/- 14 years, male=117) with HFrEF requiring hospitalization and were followed-up in a heart failure clinic. Predictors of mortality were evaluated by Cox proportional hazard analysis. RESULTS: Wide QRS complex (duration >120 ms) was present in 26% of patients, 15% with LBBB, 11% with RBBB. During an average follow-up of 1.8 +/-1.6 years, 22 patients (13%) died. By univariate analysis, presence of chronic renal insufficiency, chronic obstructive pulmonary disease, severe left ventricular systolic dysfunction and RBBB, but not LBBB were associated with increased mortality. After multivariate adjustment, the presence of RBBB was the only strong predictor of mortality in HF patients (OR 3.9, 95% CI 1.3-11.7, p < 0.05). CONCLUSION: The presence of RBBB was the only independent predictor of mortality in Thai patients with HFrEE
