Patrick Rutendo Matowa

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Pharmaceutical Technology Department, Harare Institute of Technology, Harare, Zimbabwe.
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Abstract: Background: Cardiac failure treatment largely focused on symptomatic relief at the expense of the address of the underlying disease process of cardiac remodelling. This old wisdom of practice has been turned around by clinical research findings that have shown that there are agents that reverse cardiac remodelling and offer long-term benefits to cardiac failure patients. This has led to the recommendation of evidence-based practice in chronic heart failure management using reverse modelling agents such as beta blockers. Objectives: To ascertain the prescribing patterns of beta blockers in cardiac failure patients by doctors in a public hospital setting and determine the prevalence of cardiac failure hospitalisation and the age groups involved. Study design: A retrospective medical records review observational study. Methodology: A sample size of 385 cardiac failure cases was used. Data on cardiac failure patients who were once hospitalised at the hospital of study were abstracted from the patients’ medical records files using data collection forms. Results: There were 36 (9.4%) patients who were prescribed beta blockers, 7 patients had their beta blocker substituted for another. Atenolol was prescribed to 30 (7.8%) patients, propranolol to 7 (1.8%) and carvedilol to 6 (1.6%) patients. Metoprolol and bisoprolol were not prescribed at all. There were more females (57.9%) than males (42.1%) and the mean age was 41.9 (standard deviation 24.0) years. The prevalence of cardiac failure hospitalisation was 1.54%. Conclusion: The rate of beta blocker prescribing was low. There is need for emphasis on evidence-based treatment options in the management of cardiac failure in Zimbabwe.

Keywords: Cardiac Failure, Beta Blockers, Prescribing Patterns

Cite this paper: Matowa, P. (2015) Beta Blockers Use in Cardiac Failure: Does the Current Prescribing Practice at a Large Urban Hospital in Zimbabwe Exhibit Evidence Based Care and Offer Optimal Therapy for Cardiac Failure Patients?. Pharmacology & Pharmacy, 6, 267-279. doi: 10.4236/pp.2015.65029.

References

[1]   Jay, N. (2000) Cardiac Remodelling—Concepts and Clinical Implications: A Consensus Paper from an International Forum on Cardiac Remodelling. JAAC, 45, 582-596.

[2]   Packer, M., Carver, J.R., Rhodeheffer, R.J., et al. (1991) Effect of Oral Milrinone on Mortality in Severe Chronic Heart Failure. The New England Journal of Medicine, 325, 1468-1475.
http://dx.doi.org/10.1056/NEJM199111213252103

[3]   Digitalis Investigation Group (1997) The Effects of Digoxin on Mortality and Morbidity in Patients with Heart Failure. The New England Journal of Medicine, 336, 525-533.
http://dx.doi.org/10.1056/NEJM199702203360801

[4]   Massie, B.M., Fisher, S.G., Deedwania, P.C., Singh, B.N., Fletcher, R.D. and Singh, S.N., for the CHF-STAT Investigators (1996) Effect of Amiodarone on Clinical Status and Left Ventricular Function in Patients with Congestive Heart Failure. Circulation, 93, 2128-2134.
http://dx.doi.org/10.1161/01.CIR.93.12.2128

[5]   Pieske, B. (2004) Reverse Remodelling in Heart Failure—Fact or Fiction? European Heart Journal Supplements, 6, D66-D78.
http://dx.doi.org/10.1016/j.ehjsup.2004.05.019

[6]   Fletcher, P. (2000) Cardiovascular Medicines, John Hunter Hospital, Newcastle: Beta Blockers in Heart Failure. Australian Prescriber, 23, No 6.

[7]   Hobbs, F.D.R. (2000) Management of Heart Failure: Evidence versus Practice. Does Current Prescribing Provide Optimal Treatment for Heart Failure Patients? British Journal of General Practice, 50, 735-742.

[8]   Brophy, J.M., Joseph, L. and Rouleau, J.L. (2001) Beta Blockers in Congestive Heart Failure: A Bayesian Meta-Analysis. Annals of Internal Medicine, 134, 550-560.
http://dx.doi.org/10.7326/0003-4819-134-7-200104030-00008

[9]   Dobre, D., De Jongste, M.J., Lucas, C., Cleuren, G., van Veldhuisen, D.J., Ranchor, A.V. and Haaijer-Ruskamp, F. (2007) Effectiveness of Beta Blocker Therapy in Daily Practice Patients with Advanced Chronic Heart Failure: Is There an Effect-Modification by Age? British Journal of Clinical Pharmacology, 63, 356-364.
http://dx.doi.org/10.1111/j.1365-2125.2006.02769.x

[10]   McMurray, J.J., et al. (2012) ESC Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure. European Heart Journal, 33, 1787-1847.

[11]   Eichhorn, E.J. and Bristow, M.R. (1996) Medical Therapy Can Improve the Biological Properties of the Chronically Failing Heart: A New Era in the Treatment of Heart Failure. Circulation, 94, 2285-2296.

[12]   Shibata, M.C., Flather, M.D. and Wang, D.L. (2001) Systematic Review of the Impact of Beta Blockers on Mortality and Hospital Admissions in Heart Failure. European Journal of Heart Failure, 3, 351-357.
http://dx.doi.org/10.1016/S1388-9842(01)00144-1

[13]   Ntusi, N.B. and Mayosi, B.M. (2009) Epidemiology of Heart Failure in Sub-Saharan Africa. Expert Review of Cardiovascular Therapy, 7, 169-180.

[14]   Hobbs, F.D., Jones, M.I., Allan, T.F., Wilson, S. and Tobias, R. (2000) European Survey of Primary Care Physician Perceptions on Heart Failure Diagnosis and Management. European Heart Journal, 21, 1877-1887.
http://dx.doi.org/10.1053/euhj.2000.2170

[15]   Magula, N.P. and Mayosi, B.M. (2003) Cardiac Involvement in HIV-Infected People Living in Africa: A Review. Cardiovascular Journal of Southern Africa, 14, 231-237.

[16]   Berry, C., Murdoch, D.R. and McMurray, J.J.V. (2001) Economics of Chronic Heart Failure. European Journal of Heart Failure, 3, 283-291.
http://dx.doi.org/10.1016/S1388-9842(01)00123-4

[17]   Yilmaz, M.B., Refiker, M., Guray, Y., Guray, U., Altay, H., Dermirkan, B., Caldir, V. and Korkmaz, S. (2007) Prescribing Patterns in Patients with Systolic Heart Failure at Hospital Discharge: Why Beta Blockers Are Under-Prescribed or Prescribed at Low Dose in Real Life. International Journal of Clinical Practice, 61, 225-230.
http://dx.doi.org/10.1111/j.1742-1241.2006.01157.x

[18]   Krum, H. (1999) Beta Blockers in Heart Failure. The “New Wave” of Clinical Trials. Drugs, 58, 203-210.
http://dx.doi.org/10.2165/00003495-199958020-00001

[19]   Stewart, S., Wilkinson, D., Hansen, C., Vaghela, V., Mvungi, R., McMurray, J. and Sliwa, K. (2008) Predominance of Heart Failure in the Heart of Soweto Study Cohort. Emerging Challenges for Urban African Communities. Journal of American Heart Association, 118, 2360-2367.
http://dx.doi.org/10.1161/circulationaha.108.786244

[20]   Yancy, C.W., Fowler, M.B., Colucci, W.S., Gilbert, E.M., Bristow, M.R., Cohn, J.N., Lukas, M.A., Young, S.T. and Parker, M. (2001) Race and Response to Adrenergic Blockade with Carvedilol in Patients with Chronic Heart Failure. New England Journal of Medicine, 334, 1358-1365.
http://dx.doi.org/10.1056/NEJM200105033441803

[21]   NICE5 Guidelines, CG5. Chronic Heart Failure; Management of Chronic Heart Failure in Adults in Primary and Secondary Care, July 2003.
www.nice.org.uk/guidance/cg5

[22]   Haas, S.J., Vos, T., Gilbert, R.E. and Krum, H. (2003) Are Beta Blockers as Efficacious in Patients with Diabetes Mellitus as in Patients without Diabetes Mellitus Who Have Chronic Heart Failure? A Meta-Analysis of Large-Scale Clinical Trials. American Heart Journal, 146, 848-853.
http://dx.doi.org/10.1016/S0002-8703(03)00403-4

[23]   Fuat, A., Hungin, A.P.S. and Murphy, J.J. (2003) Barriers to Accurate Diagnosis and Effective Management of Heart Failure in Primary Care: Qualitative Study. BMJ, 326, 196.
http://dx.doi.org/10.1136/bmj.326.7382.196