Impact of metoprolol treatment on cardiac function and exercise tolerance in heart failure patients with neuropsychiatric disorders

Abstract

Objective: To investigate the impact of neuropsychiatric disorders on the effect of metoprolol on cardiac and motor function in chronic heart failure (CHF) patients.

Methods: From February 2013 to April 2016, CHF patients with clinical mental disorders received metoprolol (23.75 or 47.5 mg, once daily, orally) at the Second Affiliated Hospital of Kunming Medical University. Mental status was confirmed by means of the Hospital Anxiety and Depression Scale (HADS) and the Copenhagen Burnout Inventory (CBI) scale. Cardiac function parameters such as systolic blood pressure (SBP), ejection fraction (EF) and cardiac index (CI) as well as motor function including the 6 meter walk test (6MWT) and the Veteran’s Specific Activity Questionnaire (VSAQ) were assessed as primary outcomes of the study.

Results: A total of 154 patients (median age, 66.39 years; men, n = 101) were allocated into eight groups based on their mental status. There were no significant differences in heart rate (HR) or SBP control achieved by metoprolol in any groups compared with the control (patients with normal mental status). Furthermore, biphasic ejection fraction (EF) changes were observed in all the groups with a decrease in the first month and increase from the sixth month. However, this increase was significantly lower (p < .001) than the EF achieved with metoprolol treatment in the control group except for the anxiety group. A similar pattern was seen for CI, 6MWT and VSAQ changes in all the groups. Patients in the anxiety group responded similarly to the patients with normal mental status.

Conclusion: Depressive and high burnout symptoms, but not anxiety, lower the improvement of cardiac and motor function by metoprolol treatment in CHF.

Keywords:

• Metoprolol
• CHF
• anxiety
• depression
• high burnout
• cardiac function
• motor function

Note

Transparency

Declaration of funding

This manuscript was not funded.

Authors’ contributions: All authors contributed equally to the study and development of the manuscript. J.H. and R.Z. conceptualized and designed the study. X.L. and Y.M. were involved in data collection and analysis. All the authors were involved in interpretation of results, manuscript writing and approval of the final draft.

Declaration of financial/other relationships

J.H., R.Z., X.L. and Y.M. have disclosed that they have no significant relationships with or financial interests in any commercial companies related to this study or article.

CMRO peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Notes

1 Betaloc is a registered trade name of AstraZeneca, Sweden