PROPORTION OF HEART FAILURE PATIENTS RECEIVING GUIDELINE RECOMMENDED DOSES OF BETA BLOCKERS IN GEORGIA: A STUDY ON TITRATION AND TOLERABILITY.

Abstract

Background and aims: Beta blockers are an essential part of the treatment and management of heart failure. Unfortunately, due to contraindications and side effects, it is impossible to titrate the medication to the recommended dose by available guidelines in all patients. The aim of this study was to determine the proportion of patients in Georgia receiving the maximum recommended dose of beta blockers and the proportion who could be titrated to a higher dose.

Methods: The conducted study focused on the proportion of patients in Georgia receiving the maximum recommended dose of beta blockers and the patient's receiving maximum tolerated dose of beta blockers. 300 patients with heart failure with reduced ejection fraction participated in the study. Patients were divided into 3 groups, depending on which beta blocker they were taking - bisoprolol, carvedilol or metoprolol. In patients who could not take the maximum recommended dose, an attempt was made to titrate to a higher dose.

Results: A total of 25.67% (n=77) of the 300 patients were able to reach the target dose and 223 patients were unable to reach the target dose of the medication due to various side effects. In the bisoprolol group, 19.7% reached the target dose, in the carvedilol group - 30.2% and in the metoprolol group - 31.6%. It was also noteworthy that 24.17% of patients (n=58) were able to titrate the prescribed medication to a higher dose. At the end of the study, of the 223 patients who were unable to titrate to the recommended dose of beta-blocker, 64.1% experienced bradycardia, 54.2% experienced hypotension, 32.7% experienced dyspnea, 41.3% experienced fatigue, and 38.1% experienced dizziness.

Conclusion: The inability to use beta-blockers, one of the most important medications for heart failure, is a major problem in Georgia, as only 25.67% of patients were able to take the recommended dose of the medication. Since 24.17% of patients were able to titrate to a higher dose of beta blockers, we can conclude that with long-term and careful control of heart failure some patients may be able to titrate to a higher dose of beta blockers through adaptation to the medication and to the cardiac function. It is also possible that patients were not receiving optimal medication treatment at the time of medication initiation and the medication could actually have been titrated to a higher dose. This fact highlights the importance of attempting to titrate to a higher dose of beta blockers, as 24.17% of patients saw improvement in their prescribed medication over the course of the study.