KARVEDIOL ALI BISOPROLOL PRI BOLNIKIH S SRČNIM POPUŠČANJEM IN KRONIČNO OBSTRUKTIVNO PLJUČNO BOLEZNIJO:INVESTIGATOR INITIATED (Slovene)

Chronic heart failure (CHF) is a serious, prevalent, and deadly condition. Controlled clinical trials proved the benefit of beta blockers in patients with CHF. However, epidemiological studies across Europe report failure to implement beta blockers which remain under-used and under-dosed. Several issues may contribute to the current daily practice in CHF patients. Clinical trials population does not resemble the population from the community. Fear of adverse effects as hypotension, bradycardia, fatigue or worsening of concomitant disease, especially chronic pulmonary obstructive disease (COPD) is still root-bounded. Additionally, long titration period might be important, as well as satisfaction with benefit achieved with lower doses. Trials generaly have excluded patients with COPD and we do not have any data on beta blockers in patients with concomitant CHF and COPD. Therefore, COPD still is associated with lower prescription rate of β-blockers in the everyday clinical practice. In addition, both CHF and COPD are associated with body wasting and cachexia, which is independent predictor of mortality. During last few years it has been shown that CHF patients with higher body mass index, higher total cholesterol or higher body fat mass have better clinical outcomes. Additionally, it was shown that treatment with beta blockers is associated to weight gain, also in HF patients. Based on the results of the prospective observational pilot study it seems this is mostly attributed to the accumulation of body fat.

Our results demonstrated gap between guideline recommended titration scheme and feasibility in clinical practice. We were also able to show several differences in clinical parameters between compared cardioselective and non-selective beta blockers. Cardioselective beta blockers reduced heart rate whilst non-selective had more pronounced effect on pulmonary function. Our results are particularly applicable for patients with concomitant chronic obstructive pulmonary disease where bisoprolol should be preferred beta blocker. Bisoprolol was associated with less pulmonary side effects and caused no reduction in pulmonary function tests.

Slovenia centers were part of multicenter study. Researchers are coauthors of main and secondary publications. Other studies within same study group are either ongoing or are planned.