Identifying Patients Benefiting from Beta Blocker Withdrawal in Heart Failure with Preserved Ejection Fraction

Core Concepts

Indexed left ventricular systolic volume (iLVESV) can predict patients with heart failure with preserved ejection fraction (HFpEF) and chronotropic incompetence who benefit from stopping beta blocker treatment.

Abstract

TOPLINE:

iLVESV may predict benefit from stopping beta blockers in HFpEF with chronotropic incompetence.
Chronotropic incompetence linked to worse outcomes, beta blocker withdrawal may help.
METHODOLOGY:

Post hoc analysis of PRESERVE-HR trial data on beta blocker withdrawal.
Investigated short-term effects on peak oxygen consumption (peak VO2).
TAKEAWAY:

Participants: mean age 73, 60% female.
Lower iLVESV associated with greater improvement in functional capacity.
IN PRACTICE:

Higher heart rates beneficial for HFpEF patients with smaller LV volumes.
Increased HR could enhance cardiac output in these patients.
SOURCE:

Led by Patricia Palau, MD, PhD, University of Valencia, Spain.
LIMITATIONS:

Small, open-label study with short-term follow-up.
Results may apply to stable HFpEF patients with chronotropic incompetence on beta blockers.
DISCLOSURES:

Supported by grants from Spanish Ministry of Economy and Competitiveness.

Stats

Among the 52 participants, mean resting HR was 65 bpm.
Median increase in peak HR after beta blocker cessation was plus 30 bpm.
iLVESV percentage of peak VO2 was 72.4%.
Mean chronotropic incompetence was 0.41.

Quotes

"For these patients, an increased HR could potentially enhance cardiac output and counterbalance the decrease in stroke volume during exercise."

Key Insights Distilled From

Who Benefits From Beta Blocker Withdrawal in HFpEF?

by Marilynn Lar... at www.medscape.com 02-19-2024

https://www.medscape.com/viewarticle/who-benefits-beta-blocker-withdrawal-hfpef-2024a10003bm

Deeper Inquiries

How does chronotropic incompetence impact the overall prognosis of HFpEF patients

Chronotropic incompetence in patients with heart failure with preserved ejection fraction (HFpEF) can significantly impact their overall prognosis. This inability of the heart to increase heart rate appropriately with exertion has been associated with worse clinical outcomes and reduced functional capacity in HFpEF patients. Chronotropic incompetence can lead to inadequate cardiac output during times of increased demand, potentially exacerbating symptoms and limiting exercise tolerance. Identifying and addressing this issue is crucial in managing HFpEF patients to improve their quality of life and prognosis.

What are the potential long-term effects of beta blocker withdrawal in this patient population

The potential long-term effects of beta blocker withdrawal in HFpEF patients with chronotropic incompetence are complex and require careful consideration. While short-term benefits, such as improved maximal functional capacity, may be observed in some patients, the long-term consequences of stopping beta blockers need to be thoroughly evaluated. Beta blockers are essential in managing heart failure by reducing the workload on the heart and improving outcomes. Abrupt withdrawal of beta blockers can lead to rebound effects, worsening heart failure symptoms, and potentially increasing the risk of adverse events. Therefore, the decision to withdraw beta blockers in HFpEF patients should be individualized, taking into account the patient's overall clinical status and the potential risks and benefits.

How can the findings of this study be applied to other cardiovascular conditions beyond HFpEF

The findings of this study on beta blocker withdrawal in HFpEF patients with chronotropic incompetence may have implications for other cardiovascular conditions beyond HFpEF. Understanding the impact of heart rate modulation on cardiac function and exercise capacity can be relevant in various cardiovascular diseases where chronotropic incompetence or impaired heart rate response is present. For instance, in conditions like heart failure with reduced ejection fraction (HFrEF) or certain arrhythmias, optimizing heart rate control through medication management or withdrawal strategies could potentially improve outcomes and quality of life. By identifying specific patient characteristics, such as indexed left ventricular systolic volume (iLVESV), that may predict the response to heart rate modulation, clinicians can tailor treatment approaches in a more personalized manner across different cardiovascular conditions. Further research and clinical trials are needed to explore the broader applicability of these findings in diverse cardiovascular patient populations.