Initiating low-dose beta-blockers prior to discharge in heart failure patients hospitalized for worsening symptoms significantly improves the use of a drug that has been shown in previous studies to reduce death and morbidity by more than 35 percent.

This finding is significant, said researchers from Duke University Medical Center and Northwestern University, because standard heart failure practice guidelines suggest waiting a period of two to four weeks after discharge prior to initiating beta-blocker therapy. This recommendation was based on a concern that beta-blocker initiation too soon after a hospitalization for heart failure may worsen heart failure symptoms, said the researchers.

Beta-blockers block the stimulatory effects of the neurohormones epinephrine and norepinephrine, the so-called "fight-or-flight" hormones. By blocking these hormones, beta-blockers reduce the stress on the heart and reverse myocardial remodeling. Most importantly, they have been shown to improve survival and reduce the need for hospitalization by 35 percent in several large-scale, prospective, randomized clinical trials. Despite these beneficial effects, it is estimated that nationally still only 30 to 40 percent of eligible patients receive beta-blocker therapy.

Such low usage led the researchers to initiate a trial to determine whether starting beta-blocker therapy in the hospital setting would improve usage. The results of that trial, reported November 18, 2002 at the 75th annual scientific session of the American Heart Association in Chicago, IL, show that beginning beta-blocker therapy in-hospital can achieve a 91percent usage rate 60 days after discharge.

"If we can dramatically improve the rate of beta-blocker usage by initiating therapy in-hospital, that would make a major impact on these patients' lives," said Duke cardiologist Christopher O'Connor, MD, who along with Duke's Wendy Gattis, PharmD, and Northwestern's Mihai Gheorghiade, MD, directed the trial. "Strategies like this are extremely important as the death and disability of this group of patients continues to be alarmingly high despite the availability of life-saving therapies."

The Duke researchers and colleagues from Northwestern University, UCLA, UCSD, Cleveland Clinic, and University of Texas Southwestern also are rolling out OPTIMIZE-HF (Organized Program To Improve Treatment of Hospitalized Patients with Heart Failure), a hospital- and web-based registry program that hopes to enroll up to 50,000 heart failure patients at approximately 500 hospitals across the United States. The goal of this initiative is to improve the management of heartfailure patients.