Average Resting Heart Rate in Indian Patients with Heart Failure with Reduced Ejection Fraction: Results from the Real-World Milestone Registry

Q: What are the key findings of this study?

Routine outpatient heart rate-lowering therapy in Indian HFrEF patients reduced mean resting heart rate by 6.9 bpm over 3 months (from 79.2 to 72.6 bpm; p < 0.001).

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Stable heart failure with reduced ejection fraction (HFrEF) (n=295). Intervention: Routine outpatient heart rate-lowering therapy (predominantly beta-blockers and ivabradine) vs. Baseline values (pre-post within-patient comparison). Primary outcome: Change in average resting heart rate (RHR) from baseline to 3-month follow-up (MD -6.9 bpm, p=<0.001).

Q: What does this research mean for the field?

Routine outpatient heart rate-lowering therapy in Indian patients with HFrEF significantly reduces resting heart rate, with combination therapy of beta-blockers and ivabradine achieving the greatest reduction. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To describe resting heart rate, blood pressure, and prescription patterns of heart rate-lowering therapies among Indian outpatients with stable heart failure with reduced ejection fraction.

Tiny Nair; Jagdish C Mohan; Debanu Ghosh Roy; Peeyush Jain; Asha Mahilamaran; Vivek Mahajan; Avanti Sable

doi:10.7759/cureus.119021

November 2, 2026CureusOpen Access

Average Resting Heart Rate in Indian Patients with Heart Failure with Reduced Ejection Fraction: Results from the Real-World Milestone Registry

View Full Paper

Ask AI

Bookmark

Share

Key result

Routine outpatient heart rate-lowering therapy is linked to ~7-bpm lower resting heart rate in HFrEF.

MD -6.9 bpm
P<0.001
n=295

Why the study?

Resting heart rate, blood pressure, and prescription patterns of heart rate-lowering medications in Indian outpatients with stable HFrEF in routine practice needed to be described.

Does routine outpatient management with heart rate-lowering medications (beta-blockers and ivabradine) reduce resting heart rate at 3 months in Indian patients with stable HFrEF?

Key Points

To describe resting heart rate, blood pressure, and prescription patterns of heart rate-lowering therapies among Indian outpatients with stable heart failure with reduced ejection fraction.
Conducted a prospective observational registry across 15 outpatient centers in India.
Enrolled 295 adult outpatients in New York Heart Association functional classes II to III, with 249 completing the 3-month follow-up.
Documented resting heart rate, blood pressure, and prescribed heart rate-lowering therapies at baseline and at 3 months.
Mean resting heart rate declined by 6.9 bpm, from 79.2 ± 14.9 bpm at baseline to 72.6 ± 11.1 bpm at 3 months (paired mean change -6.9 ± 11.3 bpm, p < 0.001).
Beta-blockers were prescribed to 82.0% of patients at baseline (most commonly bisoprolol) and ivabradine to 45.0%, with combination therapy linked to the largest resting heart rate reduction (-12.11 ± 10.5 bpm).
Average systolic blood pressure shifted from 120.5 ± 19.8 to 117.1 ± 17.2 mmHg (change -4.7 ± 14.0 mmHg, p < 0.001), with no adverse drug reactions reported and six deaths recorded.

Study Design

Type

Observational (n=295)

Multicenter

Yes

Structured PICO

Does routine outpatient management with heart rate-lowering medications (beta-blockers and ivabradine) reduce resting heart rate at 3 months in Indian patients with stable HFrEF?

P

Population

295 Indian outpatients with stable HFrEF (LVEF <40%, NYHA class II-III; 21.4% female; 45.4% aged 61-75 years) across 15 hospitals, followed for 3 months.

E

Exposure

Routine outpatient clinical management with heart rate-lowering medications at treating physician's discretion, predominantly beta-blockers (82.0% at baseline, mainly bisoprolol, carvedilol, metoprolol) and ivabradine (45.0% at baseline, mostly 5 mg twice daily or 10 mg once daily), as well as digoxin (13.2%) and non-dihydropyridine calcium channel blockers (1.4%, diltiazem) over 3 months.

O

Outcome

Change in average resting heart rate (RHR) in on-treatment patients from baseline to the 3-month follow-up (end of study), measured as the average of four methods: clinical palpation, 12-lead ECG, standardized automated BP apparatus, and pulse oximeter.surrogate

Main Result

Mean Difference: -6.9

Absolute Event Rate: 72.6% vs 79.2%

p-value: p=<0.001

In this real-world Indian registry of stable HFrEF outpatients, heart rate-lowering therapy (predominantly beta-blockers and ivabradine) was associated with a significant 6.9 bpm reduction in resting heart rate over 3 months, though guideline-recommended target beta-blocker doses and heart rate targets (<70 bpm) remained underachieved.

Limitations

Observational, nonrandomized design without a control group precludes causal inference
Early termination of screening during the COVID-19 pandemic led to a smaller sample size than the planned 1000 patients
Loss to follow-up of 46 patients and available-case analysis without imputation may introduce selection bias
Short 3-month follow-up duration without assessment of hard clinical outcomes such as hospitalization and mortality
Lack of adjustment for potential confounders
NT-pro-BNP data were only available in a small subset of patients (n = 61 paired values)
Observational, nonrandomized design without a control group precludes causal inference and is subject to residual confounding
Smaller sample size than planned (295 enrolled vs ~1000 planned) due to COVID-19 recruitment challenges, with 46 lost to follow-up and available-case analysis without imputation potentially introducing selection bias
Relatively short 3-month follow-up duration without formal assessment of clinical outcomes such as hospitalization and mortality
NT-pro-BNP data were only available in a small subset of patients (n = 61 with paired values)
Outpatient setting and self-reported adherence may limit generalizability

Ask about this paper

Answers are grounded in this paper and cite their sources.

Implication

Supports feasibility in Indian HFrEF outpatients; extends evidence to this population but leaves open outcome benefits.

Abstract

IntroductionThis study aimed to describe the resting heart rate (RHR), blood pressure (BP), and prescription patterns of heart rate (HR)-lowering medications in Indian patients with stable heart failure with reduced ejection fraction (HFrEF) in routine outpatient practice. MethodsThis observational study enrolled adults (New York Heart Association (NYHA) classes II-III) receiving outpatient care at 15 Indian centers.RHR, BP, and prescribed HR-lowering medications were recorded at baseline and three months. ResultsOf 295 patients, 249 completed follow-up; 78.6% were male, and ischemic etiology predominated (76.2%).Comorbidities included diabetes (54.9%), hypertension (52.8%), dyslipidemia (44.0%), chronic kidney disease (12.2%), and obesity (7.4%).Mean RHR declined by 6.9 bpm (from 79.2 ± 14.9 to 72.6 ± 11.1 bpm; paired mean change -6.9 ± 11.3 bpm, p < 0.001), with stable BP.Beta-blockers (mainly bisoprolol) were used in 82.0% of patients, although target doses were infrequently achieved.Ivabradine (mostly 5 mg twice daily) was prescribed in 45% of patients.Combination therapy was associated with the greatest observed HR reduction.N-terminal pro-B-type natriuretic peptide levels, available in a subset of patients, also decreased over the study period.No adverse reactions were reported. ConclusionPatients with HFrEF showed a high comorbidity burden but a low prevalence of obesity.Beta-blockers remained the predominant therapy, while combination therapy with beta-blockers and ivabradine was associated with the greatest observed HR reduction.Given the observational, nonrandomized design, these findings are descriptive and hypothesis-generating.

Discussion

No takes yet. Share an insight, caveat, or question.

Cite This Study

Nair et al. (2026) conducted an observational in Stable heart failure with reduced ejection fraction (HFrEF) (n=295). Routine outpatient heart rate-lowering therapy (predominantly beta-blockers and ivabradine) vs. Baseline values (pre-post within-patient comparison) was evaluated on Change in average resting heart rate (RHR) from baseline to 3-month follow-up (MD -6.9 bpm, p=<0.001). Routine outpatient heart rate-lowering therapy in Indian HFrEF patients reduced mean resting heart rate by 6.9 bpm over 3 months (from 79.2 to 72.6 bpm; p < 0.001).

synapsesocial.com/papers/6aebc8cf3e63ca1b6c315eae https://doi.org/10.7759/cureus.119021

View Full Paper

Ask AI

Bookmark

Share

Average Resting Heart Rate in Indian Patients with Heart Failure with Reduced Ejection Fraction: Results from the Real-World Milestone Registry

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Average Resting Heart Rate in Indian Patients with Heart Failure with Reduced Ejection Fraction: Results from the Real-World Milestone Registry

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Keep reading

Keep reading