Resting heart rate in patients with ischemic heart disease in Saudi Arabia and Egypt
Abdulhalim J Kinsara1, Hani K Najm, Menwar Al Anazi
1Department of Cardiology, King Abdulaziz Medical City, Jeddah, Saudi Arabia.
Insights
Many patients with coronary artery disease (CAD) have resting heart rates (RHR) above recommended levels, indicating suboptimal cardiovascular event management. Achieving target RHR is crucial for reducing mortality and improving survival in CAD patients.
Area of Science:
- Cardiology
- Clinical Medicine
- Public Health
Background:
- Stable coronary artery disease (CAD) management aims to reduce cardiovascular events and mortality.
- Resting heart rate (RHR) is a modifiable risk factor and a target for therapy in CAD.
- Current therapeutic strategies aim to achieve optimal RHR, but adherence and effectiveness vary.
Purpose of the Study:
- To assess the resting heart rate (RHR) in an outpatient population with stable coronary artery disease (CAD).
- To evaluate the association between RHR and current therapeutic management strategies for cardiovascular events.
- To identify potential gaps in achieving guideline-recommended RHR targets in CAD patients.
Main Methods:
- A multi-center cross-sectional survey conducted in Saudi Arabia and Egypt.
- Inclusion of 2049 outpatients with stable CAD without clinical heart failure (HF).
- RHR measured by manual palpitation; data analyzed for associations with medication use (beta-blockers, calcium channel blockers).
Main Results:
- The mean RHR was 78.9 ± 13.9 bpm.
- 83.1% of patients were on beta-blockers, with a mean RHR of 78.5 ± 14.0 bpm; 95.5% of these had RHR ≥ 60 bpm.
- A significant proportion of patients on beta-blockers received lower doses, and RHR remained above guideline recommendations.
Conclusions:
- Optimal target RHR was not achieved in a substantial number of screened CAD patients.
- Suboptimal RHR control may be linked to therapeutic management strategies, including lower beta-blocker dosages.
- Achieving target RHR is essential for improving outcomes, including decreased mortality and enhanced survival in CAD patients.
Aim:
To assess the level of resting heart rate (RHR) in an outpatient population presenting with stable coronary artery disease (CAD) as well as to measure its association with current therapeutic management strategies for cardiovascular events.
Materials And Methods:
A multi-center cross-sectional survey was carried out in Saudi Arabia and Egypt over a three month period (between January 2007 and April 2007). 2049 patients with CAD without clinical heart failure (HF) were included in this study through "cluster sampling". RHR was measured by manual palpitation.
Results:
Mean age of CAD patients was 56.7 ± 10.4 and the mean RHR was 78.9 ± 13.9 b/m. 1686 patients (83.1%) were on β-blockers for whom the RHR was 78.5 ± 14.0 b/m (95.5% had RHR ⩾ 60 b/m, which is higher than recommended by the guidelines). 1094 (73.5%) of patients on β-blockers were on a lower dose, probably to avoid the complications associated with such a class. Among those not on β-blockers (16.9%), RHR was 80.9 ± 13.0 b/m. Moreover, 98 patients (4.8%) were on calcium channel blocker (diltiazem or verapamil) but not on β-blockers, for whom the RHR was 80.9 ± 12.0 b/m. Finally, 163 patients (8.0%) were on both β-blockers and the calcium channel blocker, and their RHR was 79.0 ± 14.4 b/m.
Conclusion:
Optimal target RHR has not been achieved in a significant number of screened patients. Achievements of such targets are known to decrease mortality and to improve survival.
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