082 Chronic obstructive pulmonary disease: the new deal for b-blocker prescription in chronic heart failure

BackgroundThe recent European Guidelines for the treatment of CHF 2008 underlined that the majority of patient with CHF and COPD can safely tolerate β-blocker therapy.AimsThe IMPACT-RECO program III analysed the impact of NYHA class and of comorbidities on therapeutic management of French outpatients with stable CHF and left ventricular ejection fraction (LVEF) < 40%.MethodsThis survey was carried out from March 2007 to December 2007 among randomly selected French private cardiologists. 1574 patients with CHF and LVEF < 40% were included. Key demographics including comorbidities such as asthma and COPD, as well as ongoing medical treatment of CHF were collected. Physicians were asked about reasons for not prescribing β-blockers.ResultsMean age was 71±11 years, 75% of the patients were men, 34% were in NYHA class III-IV, 54% had coronary artery disease, 30% atrial fibrillation and the mean LVEF was 34±7%. 78.3% of the patients received a β-blocker, and asthma or BPCO were reported in 13.7%. 341 patients were not receiving β-blockers. The first reason for non-prescription was presumed contra-indication in 51.9% (177 pts). This contra-indication was asthma or COPD in 71%, symptomatic hypotension in 15%, bradycardia in 12% and other problems in 8%. The second reason for non prescribing β-blockers was previous side effects in 35.2% (120 pts) including heart failure decompensation in 39%, symptomatic hypotension in 36%, asthenia in 26%, bradycardia in 18%, impotence in 5% and others in 6%. Lastly, in 10.9% of patients without β-blockers, the reason for non prescription was fear of potential side effect.ConclusionRespiratory disease remains the main reason for not prescribing β-blockers in CHF despite the fact that selective β-blockers are now recommended in this population. Room remains for improvement in β-blockers prescription rate in CHF patients with concomitant COPD, underscoring the importance of pursuing education of cardiologists