Pharmacist needs help!!!

Posted by michelle on April 22, 1999 at 08:47:22
Do you have information about lower doses of B blockers being used in post MI patients?  I am a pharmacist in  a managed care organization on a cardiac care committee and some nurses said that there are some recent studies indicating that the doses of b blockers used in post mi patients are too high and lower doses would be more appropriate.  I haven't read any studies or literature about this.  Any information you have would be appreciated.

Posted by CCF CARDIO MD - MTR on April 23, 1999 at 07:58:29
Dear Michelle, thank you for your question.  Despite multiple studies proving the benefit of beta blockers in patients who have suffered a myocardial infarction, there is still no consensus on the "ideal" dose of each beta blocker to use.  Our general practice at Cleveland Clinic is to titrate the dose of a beta blocker in a post-MI patient to achieve a resting heart rate of 60-70 assuming that no hypotension or heart failure occurs.  However, there is no good clinical trial data to guide clinicians in beta blocker dosing.  Thus, I would urge you to caution your committee in making decisions to arbitrarily push for lower beta blocker doses.
I hope you find this information useful.  Information provided in the heart forum is for general purposes only.  Only your physician can provide specific diagnoses and therapies. Please feel free to write back with additional questions.  Good luck.
If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter.   The Heart Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.