accp 12 presentation efta
TRANSCRIPT
Efta Triastuti, M.Farm.Klin., Apt.
Study Program of Pharmacy, Faculty of Medicine, Brawijaya University
Malang-Indonesia
Heart Failure
Various heart
diseases
Heart function
impairment
Clinical syndromes
Quality of life reduction
High morbidity
High mortality
Therapeutic Guideline
AHA
SIGN
NICE
Previous studies
CIBIS
BEST
MERIT-HF
SENIORS
COPERNICUS
Improve QOL
Reduce Mortality
Reduce Morbidity
β blocker
surge of βadrenergic activity
in heart failure
BISOPROLOL
High β1 affinityLow effect on bronchus
No ISANo MSA
Available in Indonesia
EF
QOL
Left ventricular function
Systolic heart failure
Dr Saiful Anwar General Hospital
Cardiovascular Ambulatory Clinic
Bisoprolol
3 months Followed up
Checked “baseline” Ejection Fraction & Quality of Life Questionnaire score
Checked “endpoint” Ejection Fraction & Quality ofLife Questionnaire score
1317
Stage C Systolic Heart Failure Patients
Receiving Combination of ACE Inhibitor & Furosemide
40-80 Years of Age (n=30)
Quasi-experimental study used a one group pretest-posttest design
Added on
Stage C chronic & stable heart failure
Had Ejection Fraction reduction (EF < 50%)
Receiving optimum dose of ACE inhibitor and furosemide
Fulfill for Bisoprolol indication
Already accepted Bisoprololbefore recruitment
Acute heart failure and needed positive inotropic except digoxin
Comorbid condition which affect to quality of life such as mitral regurgitation, atrial fibrilation, & cardiogenic shock
Bradycardia (heart rate below 60 times per minute)
Hypotension with systolic pressure below 100 mmHg Severe asthma
Measured by two experts in operating Echocardiography
Simpson method of measurement as a gold standard
MinessotaLiving with
Heart Failure Questionnaire
21 questions each contained 6 choice
answers based on the symptom frequencies
The more frequent symptoms the higher questionnaire score
The worse heart failure condition & the higher
impact on QOL
Mean Baseline
EF
Mean Endpoint
EF
Mean Baseline MLHFQ
score
Mean Endpoint MLHFQ
score
Comparison method:Gaussian distribution pair t-test analysisNon-Gaussian distribution Wilcoxon analysis
30 subjectsEligible
Inclusion & exclusion
criteria screening
February -October
2011
Subjects recruitment
EF & QOL
Sex
Age
Comorbid disease Chi-Square
Analysis
Percentage (%) P value
Sex:MaleFemale
73.326,7
0.465
Age:40 to 50 years old51 to 60 years old61 to 70 years old71 to 80 years old
13.3304016,7
0.141
History of previous illness:HypertensionIschemic heart disease + HTDiabetes Mellitus + HT
26.753.320
0.061
P > 0.05 No significant
contribution between those factors to EF or
QOL
05
1015
202530354045
Baseline 3rd monthsMea
n Ej
ecti
on F
ract
ion
Perc
enta
ge
(%)
Time of Measurements (before & after BisoprololAddition)
Baseline
3rd months
EF percentage (%) P valueMean baseline 35.20 ± 8.98
0.000Mean at 3rd months 42.80 ± 10.15
Mean EF did not meet Gaussian Distribution
Non-parametric test comparison
One group pretest-posttest design
Wilcoxon analysis
44
46
48
50
52
54
56
Baseline 3rd months
Mea
n Q
OL
Que
stio
nnai
re S
core
Time of Measurements (before & after Bisoprolol Addition)
Baseline
3rd months
Mean QOL Questionnaire Score P value
Mean baseline 54.93 ± 9.610.000
Mean at 3rd months 48.27 ± 8.57
Mean QOL questionnaire score met Gaussian Distribution
Parametric test comparison
One group pretest-posttest design
Paired t test analysis
Bisoprolol
Decrease heart rate
Cardiac oxygen demand
reduction
ischemic-related symptoms relieve
QOL improvement
Adequate filling &
loading time
Increase cardiac output by increasing stroke volume though heart rate decline
Increase Ejection Fraction by reduce blood volume which
left in the ventricle
Inhibit renin
release
Aldosterone antagonistic
effect
Decrease water & sodium retention
Cardiac load reduction
Slow down HF-related cardiomyopathy progression
No ISA high effect on HR reduction
No MSA minimum effect on cardiac conductance