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      Dose-independent influence of metoprolol on cardiac and motor functions, QoL, and mental status in Chinese patients with CHF

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          Abstract

          Objective

          The objective of the study was to evaluate the dose-related influence of metoprolol on cardiac performance, motor function, quality of life (QoL), and mental status in Chinese patients with chronic heart failure (CHF).

          Patients and methods

          This was a prospectively designed single-center study which enrolled CHF patients with resting heart rate (HR) >80 bpm belonging to the New York Heart Association (NYHA) III/IV functional classification. Patients were initiated with 12.5 mg of metoprolol, and every second week, the dose was escalated until the target HR level (60–70 bpm) was achieved during the follow-up at 1st, 3rd, 6th, and 12th months. Patients were divided into two groups depending on the doses administered: 47.5 mg (n=37) and 118.75 mg (n=74), respectively, for comparison in terms of change in cardiac function, motor function, QoL, and mental status.

          Results

          Among the 111 patients with CHF, no significant difference was shown between the two doses administered. Irrespective of the dose, the cardiac performance, motor function, QoL, and anxiety improved and there was an increase in depression, whereas the effect on burnout, calculated as Copenhagen Burnout Inventory (CBI), equally was insignificant throughout the 1-year follow-up period in both the CHF patient groups.

          Conclusion

          Lower dose of metoprolol (47.5 mg) is as effective as higher dose (118.75 mg) in Chinese population with CHF to improve the cardiac function, motor function, QoL, and mental status.

          Most cited references45

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          Irbesartan in patients with heart failure and preserved ejection fraction.

          Barry M. Massie, Peter E. Carson, John J McMurray … (2008)
          Approximately 50% of patients with heart failure have a left ventricular ejection fraction of at least 45%, but no therapies have been shown to improve the outcome of these patients. Therefore, we studied the effects of irbesartan in patients with this syndrome. We enrolled 4128 patients who were at least 60 years of age and had New York Heart Association class II, III, or IV heart failure and an ejection fraction of at least 45% and randomly assigned them to receive 300 mg of irbesartan or placebo per day. The primary composite outcome was death from any cause or hospitalization for a cardiovascular cause (heart failure, myocardial infarction, unstable angina, arrhythmia, or stroke). Secondary outcomes included death from heart failure or hospitalization for heart failure, death from any cause and from cardiovascular causes, and quality of life. During a mean follow-up of 49.5 months, the primary outcome occurred in 742 patients in the irbesartan group and 763 in the placebo group. Primary event rates in the irbesartan and placebo groups were 100.4 and 105.4 per 1000 patient-years, respectively (hazard ratio, 0.95; 95% confidence interval [CI], 0.86 to 1.05; P=0.35). Overall rates of death were 52.6 and 52.3 per 1000 patient-years, respectively (hazard ratio, 1.00; 95% CI, 0.88 to 1.14; P=0.98). Rates of hospitalization for cardiovascular causes that contributed to the primary outcome were 70.6 and 74.3 per 1000 patient-years, respectively (hazard ratio, 0.95; 95% CI, 0.85 to 1.08; P=0.44). There were no significant differences in the other prespecified outcomes. Irbesartan did not improve the outcomes of patients with heart failure and a preserved left ventricular ejection fraction. (ClinicalTrials.gov number, NCT00095238.) 2008 Massachusetts Medical Society
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            Outcome of heart failure with preserved ejection fraction in a population-based study.

            R Sacha Bhatia, Jack V Tu, Douglas S Lee … (2006)
            The importance of heart failure with preserved ejection fraction is increasingly recognized. We conducted a study to evaluate the epidemiologic features and outcomes of patients with heart failure with preserved ejection fraction and to compare the findings with those from patients who had heart failure with reduced ejection fraction. From April 1, 1999, through March 31, 2001, we studied 2802 patients admitted to 103 hospitals in the province of Ontario, Canada, with a discharge diagnosis of heart failure whose ejection fraction had also been assessed. The patients were categorized in three groups: those with an ejection fraction of less than 40 percent (heart failure with reduced ejection fraction), those with an ejection fraction of 40 to 50 percent (heart failure with borderline ejection fraction), and those with an ejection fraction of more than 50 percent (heart failure with preserved ejection fraction). Two groups were studied in detail: those with an ejection fraction of less than 40 percent and those with an ejection fraction of more than 50 percent. The main outcome measures were death within one year and readmission to the hospital for heart failure. Thirty-one percent of the patients had an ejection fraction of more than 50 percent. Patients with heart failure with preserved ejection fraction were more likely to be older and female and to have a history of hypertension and atrial fibrillation. The presenting history and clinical examination findings were similar for the two groups. The unadjusted mortality rates for patients with an ejection fraction of more than 50 percent were not significantly different from those for patients with an ejection fraction of less than 40 percent at 30 days (5 percent vs. 7 percent, P=0.08) and at 1 year (22 percent vs. 26 percent, P=0.07); the adjusted one-year mortality rates were also not significantly different in the two groups (hazard ratio, 1.13; 95 percent confidence interval, 0.94 to 1.36; P=0.18). The rates of readmission for heart failure and of in-hospital complications did not differ between the two groups. Among patients presenting with new-onset heart failure, a substantial proportion had an ejection fraction of more than 50 percent. The survival of patients with heart failure with preserved ejection fraction was similar to that of patients with reduced ejection fraction. Copyright 2006 Massachusetts Medical Society.
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              Depression in heart failure a meta-analytic review of prevalence, intervention effects, and associations with clinical outcomes.

              Thomas Rutledge, Veronica Reis, Sarah E Linke … (2006)
              This article describes a meta-analysis of published associations between depression and heart failure (HF) in regard to 3 questions: 1) What is the prevalence of depression among patients with HF? 2) What is the magnitude of the relationship between depression and clinical outcomes in the HF population? 3) What is the evidence for treatment effectiveness in reducing depression in HF patients? Key word searches of the Medline and PsycInfo databases, as well as reference searches in published HF and depression articles, identified 36 publications meeting our criteria. Clinically significant depression was present in 21.5% of HF patients, and varied by the use of questionnaires versus diagnostic interview (33.6% and 19.3%, respectively) and New York Heart Association-defined HF severity (11% in class I vs. 42% in class IV), among other factors. Combined results suggested higher rates of death and secondary events (risk ratio = 2.1, 95% confidence interval 1.7 to 2.6), trends toward increased health care use, and higher rates of hospitalization and emergency room visits among depressed patients. Treatment studies generally relied on small samples, but also suggested depression symptom reductions from a variety of interventions. In sum, clinically significant depression is present in at least 1 in 5 patients with HF; however, depression rates can be much higher among patients screened with questionnaires or with more advanced HF. The relationship between depression and poorer HF outcomes is consistent and strong across multiple end points. These findings reinforce the importance of psychosocial research in HF populations and identify a number of areas for future study.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Ther Clin Risk Manag
                Journal ID (iso-abbrev): Ther Clin Risk Manag
                Journal ID (publisher-id): Therapeutics and Clinical Risk Management
                Title: Therapeutics and Clinical Risk Management
                Publisher: Dove Medical Press
                ISSN (Print): 1176-6336
                ISSN (Electronic): 1178-203X
                Publication date Collection: 2019
                Publication date (Electronic): 18 December 2018
                Volume: 15
                Pages: 23-31
                Affiliations
                Department of Cardiology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650101, People’s Republic of China, mengyong76@ 123456gmail.com
                Author notes
                Correspondence: Yong Meng, Department of Cardiology, The Second Affiliated Hospital of Kunming Medical University, No 374, Dianmian Road, Kunming, Yunnan 650101, People’s Republic of China, Tel +86 153 6813 7676, Fax +86 153 6813 7678, Email mengyong76@ 123456gmail.com
                Article
                Publisher ID: tcrm-15-023
                DOI: 10.2147/TCRM.S188123
                PMC ID: 6302828
                SO-VID: e991a4c2-3659-4eaf-81d9-2a9d954e4ad7
                Copyright © © 2019 Zhang et al. This work is published and licensed by Dove Medical Press Limited
                License:

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

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                Subject: Original Research

                ScienceOpen disciplines: Medicine
                Keywords: metoprolol,heart rate,motor function,quality of life,mental status,ejection fraction
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: metoprolol, heart rate, motor function, quality of life, mental status, ejection fraction

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