Abstract

Do Beta Adrenoceptor Blocking Agents Provide the Same Degree of Clinically Convincing Morbidity and Mortality Benefits in Patients with Chronic Heart Failure

Chronic heart failure has been extensively characterized as a disorder arising from a complex ŝnƚĞƌĂcÆŸŽn between impaired ventricular performance and neurohormonal Ä‚cƟǀĂƟŽn͘ Since beta adrenoceptor blocking agents are currently considered an integral component of therapy for the management of ƉĂƟĞnƚƐ with severe chronic heart failure; several well designed clinical trials have been conducted to determine the morbidity and mortality bÄžnÄžĮƚƐ of these agents. These studies however did not yield the same results in terms of morbidity and mortality bÄžnÄžĮƚƐ͘ Currently only Bisoprolol, Carvedilol and sustained release metoprolol succinate have clinically proven and convincing morbidity and mortality bÄžnÄžĮƚƐ͘ The current list of approved medicines of the NÄ‚ÆŸŽnÄ‚ů Health Insurance Scheme (NHIS) of the republic of Ghana does not provide coverage for these live saving ƚŚĞƌĂƉĞƵÆŸc agents. The ŽbÅ©ÄžcƟǀĞ of this review is to collate the relevant ƐcŝĞnÆŸĮc evidence that will convince the Ä‚ƵƚŚŽÆŒÅÆŸÄžÆ at the NÄ‚ÆŸŽnÄ‚ů Health Insurance Authority (NHIA) of the Republic of Ghana to include at least one of the evidence based beta adrenoceptor blocking agents in the list of approved medicines. A thorough search on the internet was conducted using Google scholar to obtain only the clinically relevant studies associated with the bÄžnÄžĮƚƐ of beta adrenoceptor blocking agents in ƉĂƟĞnƚƐ with chronic heart failure published in the English language. The phrases beta adrenoceptor blocking agents and chronic heart failure were used as search engines. The search engine yielded several studies that met the ƉƌĞĚĞĮnĞĚ inclusion criteria. However, only the Cardiac /nƐƵĸcŝĞncLJ BIsoprolol Studies (CIBIS-I and CIBIS-II), Carvedilol WÆŒŽÆÆ‰ÄžcƟǀĞ Randomized CƵmƵůĂƟǀĞ Survival Study (COPERNICUS) and Metoprolol CR/XL Randomized /nƚĞƌǀĞnÆŸŽn Trial (MERIF-HF) because of the clinical relevance of their Ä®nĚŝnŐƐ Beta adrenoceptor blocking agents such as atenolol and propranolol have been used in the management of ƉĂƟĞnƚƐ with chronic heart failure. However, their ÄžĸcÄ‚cLJ and ŽÆ‰ÆŸmÄ‚ů dose in reducing mortality have not been ƐcŝĞnÆŸĮcÄ‚ůůLJ established Not all beta adrenoceptor blocking agents ƐcŝĞnÆŸĮcÄ‚ůůLJ studied provide the same degree of clinically meaningful and convincing morbidity and mortality bÄžnÄžĮƚƐ in ƉĂƟĞnƚƐ with chronic heart failure.


Author(s): Martin Mumuni Danaah Malick

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