β blockers in older persons with heart failure:: tolerability and impact on quality of life

Objective: To determine tolerability and symptom changes associated with the introduction of bisoprolol treatment in older patients with heart failure. Design: Prospective observational cohort study. Setting: Geriatric medicine outpatient department of a university hospital. Patients: 51 patients (mean age 78 years, range 70-89 years) with stable symptomatic heart failure caused by left ventricular systolic dysfunction. Interventions: Bisoprolol tablets, 1.25-10.0 mg. Main outcome measures: Tolerability; changes in symptoms and exercise tolerance. Results: 69% of patients tolerated bisoprolol. Mean tolerated dose was 7.6 mg. There was no change in symptoms or exercise capacity in those who tolerated bisoprolol. Perceived health status and symptoms of anxiety and depression improved during the titration period. Conclusions: The rate of withdrawal from bisoprolol treatment in older patients with congestive heart failure was twice that previously reported in younger patients. The mean tolerated dose was similar to that found in trials reporting clinical efficacy. There was no evidence of a negative impact on symptoms or exercise capacity in patients who tolerated bisoprolol.