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Procoralan plus beta-blockers as first-step therapy in heart failure?

Procoralan plus beta-blockers as first-step therapy in heart failure?. Effects of ivabradine plus beta blockers as first step therapy on heart rate, compliance, quality of life and exercise tolerance in patients with chronic heart failure

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Procoralan plus beta-blockers as first-step therapy in heart failure?

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  1. Procoralan plus beta-blockers as first-step therapy in heart failure? Effects of ivabradine plus beta blockers as first step therapy on heart rate, compliance, quality of life and exercise tolerance in patients with chronic heart failure A. Macchi1, I. Franzoni1, I. Rosa1, M.C. Pedrigi1, F. Buzzetti1, R. Gorla1, G.V. Gaudio2, P.G. Camici1, A. Margonato1 1.San Raffaele Hospital, Milan, Italy; 2. Antonio Abate Hospital, Somma Lombardo (VA), Italy

  2. Rationale & objective • Rationale • Beta-blockers are a cornerstone of chronic heart failure treatment and when added to renin-angiotensin-aldosterone system antagonists further reduce mortality and morbidity. • Because of side effects (hypotension, asthenia, dyspnea, claudication), few patients reach optimal doses of beta-blockers and optimal heart rate. • Procoralan, which is devoid of effects on hemodynamics and contractility, has proven effective in reducing mortality and hospitalization for heart failure. • Objective • To evaluate the effects of a combination of beta-blockers and Procoralan versus beta-blockers alone on heart rate, compliance to therapy, quality of life, and exercise tolerance.

  3. Study design • Patients • 111 patients (87 males, 62±7 years) with stable heart failure (NYHA IIb-III) • Ejection fraction <35% • Renin-angiotensin-aldosterone system antagonists and diuretics • No beta-blockers • Heart rate at rest >70 bpm, in sinus rhythm • Methods • Prospective, randomized, open, blinded end point design study Beta-blockers Baseline • Resting heart rate • Quality of life, symptoms • ETT parameters (modified Bruce protocol) Increase dose of beta-blocker or Procoralan if possible • Resting heart rate • Quality of life, symptoms • ETT parameters (modified Bruce protocol) Procoralan + beta-blockers 6 weeks 3 weeks

  4. Procoralan plus beta-blocker as first-step combination therapy in heart failure increases exercise capacity TED (Total exercise duration), min P=0.05 Baseline Baseline 6 weeks 6 weeks Procoralan + beta-blockers (n= 56) Uptitration of beta-blockers (n=55) Mean daily dose, mg: 1st group – Procoralan, 12.5; Bisoprolol, 3.6; Carvedilol, 13.4; Nebivolol, 12;5; 2nd group – Bisoprolol, 5.4; Carvedilol, 25.3; Nebivolol, 5.1 Macchi A, et al. Eur Heart J. 2011;32( Abstract Supplement ):641-642; Abs 3720

  5. Procoralan plus beta-blocker as first-step combination therapy in heart failure improves quality of life Quality of life scale P<0.001 6 weeks Baseline 6 weeks Baseline Procoralan + beta-blockers (n= 56) Uptitration of beta-blockers (n=55) Macchi A, et al. Eur Heart J 2011;32( Abstract Supplement):641-642; Abs 3720

  6. Conclusions • The combination of Procoralan with a beta-blocker can be introduced safely as first-step therapy in chronic heart failure. • This combination ensures optimal heart rate control, and ameliorates exercise capacity and quality of life compared with beta-blocker alone. • The combination of Procoralan with a beta-blocker is well tolerated compared with beta-blocker alone.

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