I was just curious, since the two cardiac units I've had clinical in seem to use Coreg for many patients with HF. Do your facilities have different standards for all patients with HF?

Think about what beta blockers do. How do they affect HR, CO and peripheral vascular resistance? What effect does this all have to do with workload of the heart and blood pressure? How could this effect be beneficial in HF patients?

I recommend looking up the AHA Get With the Guidelines heart failure recommendations. Cardioselective BBs (Corey, metoprolol SR) are indicated as they have been shown to improve mortality. Additionally an ACEI or ARB are recommended for all patients able to tolerate them. In addition, BiDil is recommended for African Americans. Loop diuretics and potassium sparing diuretics are also indicated, as well as anti coagulation for patients with A Fib.

Think about what beta blockers do. How do they affect HR, CO and peripheral vascular resistance? What effect does this all have to do with workload of the heart and blood pressure? How could this effect be beneficial in HF patients?

I understand what Coreg is and what it does, but I was curious to know if most patients with HF receive this drug in the hospital as part of a standard treatment.

I recommend looking up the AHA Get With the Guidelines heart failure recommendations. Cardioselective BBs (Corey, metoprolol SR) are indicated as they have been shown to improve mortality. Additionally an ACEI or ARB are recommended for all patients able to tolerate them. In addition, BiDil is recommended for African Americans. Loop diuretics and potassium sparing diuretics are also indicated, as well as anti coagulation for patients with A Fib.

I will look that up. Thanks. Does your facility use Coreg as part of the standard of treatment if it is one of those drugs that improves mortality rates in the HF patients?

You're welcome. Yes. Either Coreg, metoprolol succinate SR, or bisoprolol. We have a team of heart failure NPs whose job it is to evaluate whether patients are getting treatment according to the guidelines. They also educate the patients on managing their disease and follow them outpatient in our heart failure clinic.

The Importance of Beta Blockers in the Treatment of Heart Failure - American Family Physician

Medscape: Medscape Access

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You're welcome. Yes. Either Coreg, metoprolol succinate SR, or bisoprolol. We have a team of heart failure NPs whose job it is to evaluate whether patients are getting treatment according to the guidelines. They also educate the patients on managing their disease and follow them outpatient in our heart failure clinic.

Thank you for sharing. It is interesting that the NPs are involved with that at your facility. So I guess like other diseases, there's standards of care for HF as well.

Thanks for the links as well!

Beta blockers, not limited to coreg, are recommended for HF. Coreg has an added alpha effect that can further reduce afterload similar to the effect of an ACE inhibitor, the downside is that you can't titrate the two effects separately. The evidence that coreg is more effective than a beta blocker and additional afterload reducer is controversial.

Beta blockers, not limited to coreg, are recommended for HF. Coreg has an added alpha effect that can further reduce afterload similar to the effect of an ACE inhibitor, the downside is that you can't titrate the two effects separately. The evidence that coreg is more effective than a beta blocker and additional afterload reducer is controversial.

Ah, I see. So beta blockers in general are more of a standard.

Hi! Look for the patient's EF. The lower the EF, the more likely it is they will start coreg as opposed to metoprolol.

I recommend looking up the AHA Get With the Guidelines heart failure recommendations. Cardioselective BBs (Corey, metoprolol SR) are indicated as they have been shown to improve mortality. Additionally an ACEI or ARB are recommended for all patients able to tolerate them. In addition, BiDil is recommended for African Americans. Loop diuretics and potassium sparing diuretics are also indicated, as well as anti coagulation for patients with A Fib.

Coreg is non-cardioselective, though.

Metoprolol, Esmolol, and Atenolol are the main cardioselecive BBs.