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© 2005 European Society of Cardiology
Programme to improve the use of beta-blockers for heart failure in the elderly and in those with severe symptoms: Results of the BRING-UP 2 Study
a Department of Cardiology, Salvatore Maugeri Foundation Pavia, Italy
b Department of Cardiology, San Giovanni Hospital Rome, Italy
c Rehabilitation Unit, Clinic Center Naples, Italy
d Cardiology Unit, Presidio Ospedaliero Villa Sofia Palermo, Italy
e Department of Cardiology, I.N.R.C.A. Rome, Italy
f Department of Cardiology-Cattinara Hospital, University and Riuniti Hospital Trieste, Italy
g Department of Cardiology, Ospedale Civile dello Spirito Santo Pescara, Italy
h Department of Cardiology, Spedali Civili Brescia, Italy
i Cardiology Unit 2, Niguarda Hospital Milan, Italy
j ANMCO Research Center Florence, Italy
k Department of Cardiology, San Michele Brotzu Hospital Cagliari, Italy
l Cardiology Unit I, San Camillo Hospital Rome, Italy
m Interventional Cardiology and ICU, G. Rummo Hospital Benevento, Italy
n Department of Cardiology, IRCCS San Matteo Hospital Pavia, Italy
* Corresponding author. ANMCO Research Center-Via La Marmora, 34-50121 Florence, Italy. Tel. +39 055 5001703, +39 055 588972; fax: +39 055 583400. E-mail address: centro_studi{at}anmco.it (C. Opasich).
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Abstract |
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Background: Beta-blockers are underused in HF patients, thus strategies to implement their use are needed.
Objectives: To improve beta-blocker use in elderly and/or patients with severe heart failure (HF) and to evaluate safety and outcome.
Methods: Patients with symptomatic HF and age 
70 years or left ventricular EF < 25% and symptoms at rest were enrolled, including those already on beta-blocker treatment. Patients who were not receiving a beta-blocker were considered for carvedilol treatment. All patients were followed up for 1-year.
Results: Of the 1518 elderly patients, 505 were already on beta-blockers, and carvedilol was newly prescribed in 419 patients. At 1-year, patients treated with carvedilol had a lower incidence of death [10.8% vs. 18.0% in already treated (adjusted RR 0.68; 95%CI 0.49–0.96) and 11.2% in newly treated patients (adjusted RR 0.68; 95%CI 0.48–0.97)].
Of the 709 patients with severe HF, 38.4% were already on beta-blockers, and carvedilol was newly prescribed in 189 patients. Patients not treated with carvedilol showed the worst clinical outcome. Total rate of discontinuation (including adverse reaction and non-compliance) was 14% and 9%, respectively, in elderly and severe patients.
Conclusions: In a real world setting, beta-blocker treatment was not associated with an increased risk of adverse events in elderly and severe HF patients.
Key Words: Beta-blockers • Heart failure • Elderly
Received May 3, 2005; Revised September 5, 2005; Accepted November 14, 2005
1 See the Appendix for a complete list of participating Centers and Investigators. The study was supported in part by Roche Spa Italy.
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