A Survey Of β Blocker's Use In Patients Of Chronic Systolic Heart Failure Or Coronary Heart Disease

[Objective] Study the use ofβ-blocker and the control of heart rate in patients with coronary heart disease or chronic systolic heart failure.Search for reason ofβ-blocker's not use or not use in sufficient quantities. To be a reference for the reasonable clinical use ofβblockers.[Methods] Select 328 cases of hospitalized patients with coronary heart disease and 240 cases with chronic systolic heart failure (NYHAI～Ⅲ) in the Department of Cardiology, Shandong Provincial Hospital from May 2009 to May 2010. Patients with coronary heart diseases were divded into metoprolol group(60cases), sustained release tablets of metoprolol tartrate group (162cases), bisoprolol group(98cases)and the group with no drug. The type and dose of p-blocker and the patients'heart rates were recorded at the time of their admission and discharge. Calculate the medication rate and mean doses of three commonly used drugs:metoprolol tartrate, sustained release tablets of metoprolol tartrate,fumarate Bisoprolol.Calculate average heart rates of patients after medication and Compliance rate of heart rate.Calculate the rate of dosing and the rate of side effect.Search for reason ofβ-blocker's not use or not use in sufficient quantities (if drug contraindications are all reasons). [Results]1. The situation of admission:1.1 Patients with coronary heart diseaseAverage dose of metoprolol tablets at admission:40.43±25.05mg/d;sustained release tablets of metoprolol:38.42±23.03mg/d;bisoprolol:3.82±2.03mg/d; average heart rate:metoprolol tablets:73.64±15.79bpm sustained release tablets of metoprolol 80.09±7.62bpm Bisoprolo180.06±7.42bpm; Compliance rate of heart rates:Metoprolol tablets 7.1%;sustained release tablets of metoprolol:5.9%; Bisoprolol:5.6%; rates of side effects (%)metoprolol tablets:7.1; sustained release tablets of metoprolol 2.9; Bisoprolol 0; Common average heart rate:77.94±20.18bpm; common compliance rate of heart rates:4.1% common rate of medication:97.6%1.2 Patients with chronic systolic heart failureAverage dose of metoprolol tablets at admission:41.33±24.15mg/d;sustained release tablets of metoprolol:39.42±21.13mg/d;bisoprolol:3.74±1.93mg/d; average heart rate:metoprolol tablets72.30±14.67bpm sustained release tablets of metoprolol 81.12±7.54bpm Bisoprolol 79.11±7.22bpm; Compliance rate of heart rates: Metoprolol tablets 7.7%;sustained release tablets of metoprolol 5.5%; Bisoprolo16.7%; rates of side effects:metoprolol tablets 7.1%; sustained release tablets of metoprolol 2.9%; Bisoprolol 0% Common average heart rate:77.73±20.18bpm; common compliance rate of heart rates:6.3% common rate of medication:96.7%2.The situation of discharge2.1 Patients with coronary heart diseaseAverage dose of metoprolol tablets:45.14±20.26mg/d;sustained released tablets of metoprolol 57.06±35.23mg/d;bisoprolol5.13±3.13mg/d; average heart rate: metoprolol tablets64.72±13.64bpm sustained release tablets of metoprolol 66.27±9.06bpm Bisoprolol 66.44±10.79bpm; Compliance rate of heart rates:Metoprolol tablets 35.11% sustained release tablets of metoprolol 29.73% Bisoprolo122.22%; rates of side effects:metoprolol tablets 2.9% sustained release tablets of metoprolol 0% Bisoprolol 0% Common average heart rate:65.23±9.13bpm; common compliance rate of heart rates:28.14% common rate of medication:97.6%2.2 Patients with chronic systolic heart failureAverage dose of metoprolol tablets:46.34±22.23mg/d;sustained release tablets of metoprolol:57.87±34.35mg/d;bisoprolol:5.34±3.24mg/d; average heart rate: metoprolol tablets65.62±13.47bpm sustained release tablets of metoprolol 67.24±9.13bpm Bisoprolol 65.47±11.17bpm; Compliance rate of heart rates:Metoprolol tablets 37.13%;sustained release tablets of metoprolol 29.58%; Bisoprolol 22.31%; rates of side effects metoprolol tablets 2.5%; sustained release tablets of metoprolol 0% Bisoprolol 0% Common average heart rate:66.23±9.13bpm; common compliance rate of heart rates:29.14% common rate of medication:96.7%3. The differnce of drug use between admission and discharge3.1 Patients with coronary heart diseaseMean dosage level of Metoprolol tablets on admission was 40.43±25.05mg/d, for the discharge:45.14±20.26mg/d (P>0.05); Mean dosage level of sustained release tablets of metoprolol on admission was 38.42±23.03mg/d, the average dosage of discharge was 57.06±35.23mg/d (P<0.05); average dosage of bisoprolol on admission was 3.82±2.03mg/d, at discharge was 5.13±3.13mg/d (P<0.05).3.2 Patients with chronic systolic heart failureMean dosage level of Metoprolol tablets on admission was 41.33±24.15mg/d, for the discharge:46.34±22.23mg/d (P>0.05); Mean dosage level of sustained release tablets of metoprolol on admission was 39.42±21.13mg/d, the average dosage of discharge was 57.87±34.35mg/d (P<0.05); average dosage of bisoprolol on admission was 3.74±1.93mg/d, at discharge was 5.34±3.24mg/d (P<0.05).4.The differnce of hart rate between admission and discharge4.1 Patients with coronary heart diseaseMean heart rate of patints who used Metoprolol tablets on admission was 73.64±15.79bpm, for the discharge:64.72±13.64bpm (P>0.05); Mean heart rate of patints who used sustained release tablets of metoprolol on admission was 80.09±7.62bpm, the average heart rate of discharge was 66.27±9.06bpm P<0.05; Mean heart rate of patints who used bisoprolol on admission was 80.06±7.42bpm, at discharge was66.44±10.79bpm P<0.05; Mean heart rate of patints who did not use any drug on admission:65.25±15.13bpm, the average heart rate of discharge:65.25±9.64bpm P <0.05.4.2 Patients with chronic systolic heart failureMean heart rate of patints who used Metoprolol tablets on admission was 72.30±14.67bpm, for the discharge:65.62±13.47bpm (P>0.05); Mean heart rate of patints who used sustained release tablets of metoprolol on admission was 81.12±7.54bpm, the average heart rate of discharge was 67.24±9.13bpm P<0.05; Mean heart rate of patints who used bisoprolol on admission was 79.11±7.22bpm, at discharge was65.47±11.17bpm P<0.05; Mean heart rate of patints who did not use any drug on admission:65.47±13.17bpm, the average heart rate of discharge 66.27±9.34bpmP<0.05.5.Other casesDays of hospital:patients with coronary heart disease8.56±3.15days patients with chronic systolic heart failure 10.11±4.26days Numbers and rates of patients given drugs uncoupled with guidelines:patients with coronary heart disease 302 cases (92.07%) patients with chronic systolic heart failure 225 cases (93.75%) The rates of patients given no drugs because of contraindications:patients with coronary heart disease 100% patients with chronic systolic heart failure 100%[Conclusion]1.The common medication rate ofβ-blocker was reasonable and the reasons for no use of drug were all contraindications.2. The rate of reaching goal dose was low.average dosage and goal doses recommended by guidelines varied greatly.3.The complicance rate of heart rate is low and the majority of patients had higher heart rates4.Mean medication dose and the complicance rate of heart rate were higher at discharge than those at admission.The difference was statistically significant.5.It was indicated that the use ofβ-blocker was still different from guidelines.Simutaneously the difference was known and the situation was being better.