Heart rate, beta-blocker use, and outcomes of heart failure with reduced ejection fraction
Why the study?
Is resting heart rate or beta-blocker dose more closely associated with adverse outcomes in patients with HFrEF?
Population
6,071 patients with chronic HFrEF in sinus rhythm with at least 1 year of follow-up and available serial…
Design
Cohort
Follow-up
median 1330 days
Authors
Discussion
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Member takes
Implication
Heart rate was associated with adverse outcomes independent of beta-blocker dose; leaves open whether targeted rate control improves prognosis in HFrEF.
Key Points
- To evaluate the relationship between resting heart rate, guideline-directed beta-blocker dosing, and clinical outcomes in patients with heart failure with reduced ejection fraction.
- Retrospective cohort analysis of 6,071 patients with chronic heart failure with reduced ejection fraction (ejection fraction ≤35%) in sinus rhythm from an integrated health network (2000–2014).
- Followed patients for a median of 1,330 days across 73,586 clinical visits with serial heart rate and prescription data.
- Patients spent 61.2% of follow-up time with a heart rate ≥70 bpm, with only 27.9% receiving ≥50% of target beta-blocker dose at baseline.
- Higher baseline heart rate was associated with increased risk of all-cause mortality or heart failure hospitalization (HR 1.28 per 15 bpm increase, P < 0.001), whereas beta-blocker dose was not significantly associated (HR 0.97 per 77.2 mg increase, P = 0.36).
- The hazard for heart failure hospitalization was more closely linked to resting heart rate than to beta-blocker dose (P = 0.01).
Structured PICO
Is resting heart rate or beta-blocker dose more closely associated with adverse outcomes in patients with HFrEF?
P
Population
6,071 patients with chronic HFrEF (ejection fraction ≤35%) in sinus rhythm with at least 1 year of follow-up and available serial heart rate and medication data
I
Intervention
High resting heart rate (≥70 b.p.m.) and beta-blocker therapy
O
Outcome
Composite of all-cause mortality or heart failure (HF) hospitalizationcomposite
In patients with HFrEF, elevated resting heart rate is common and strongly associated with adverse outcomes, highlighting an opportunity to improve guideline-directed medical therapy for heart rate control.
Cite This Study
Ibrahim et al. (2018) studied this question.