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Heart rate achieved or beta-blocker dose in patients with chronic heart failure: which is the better target?

Damien Cullington1, Kevin M Goode, Andrew L Clark

  • 1Department of Cardiology, Post graduate Medical Institute (Hull York Medical School), University of Hull, UK.

European Journal of Heart Failure
|May 25, 2012
PubMed

Insights

For chronic heart failure patients, resting heart rate at follow-up, not beta-blocker dose, predicts mortality. A target heart rate may improve outcomes in heart failure management.

Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • Beta-blockers are known to reduce mortality in chronic heart failure (CHF) with left ventricular systolic dysfunction (LVSD).
  • The precise mechanism by which beta-blockers improve outcomes in these patients remains uncertain.

Purpose of the Study:

  • To determine if beta-blocker dosage or heart rate is a stronger predictor of mortality in patients with CHF and LVSD.
  • To investigate the relationship between heart rate, beta-blocker dose, and survival.

Main Methods:

  • A cohort of 654 patients with ejection fraction ≤40% in sinus rhythm were followed for up to 36 months.
  • Multivariable models were used to examine the associations between heart rate, beta-blocker dose, and survival at initial and follow-up visits.
  • Beta-blocker use increased from 58% to 82% during the study.

Main Results:

  • Neither initial heart rate nor beta-blocker dose predicted mortality.
  • Resting heart rate at the 4-month follow-up visit was a significant predictor of mortality (P=0.02).
  • Patients with a heart rate of 58-64 bpm at follow-up had the best prognosis; beta-blocker use was associated with better outcomes, but dose did not significantly vary prognosis.

Conclusions:

  • Both beta-blocker use and resting heart rate at follow-up independently predict prognosis in CHF patients with LVSD.
  • Beta-blocker dose was not found to be a significant predictor of mortality.
  • Targeting a specific heart rate range may be a beneficial therapeutic goal in managing CHF.
Abstract

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