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Heart rate and B-blockade in stable coronary artery disease in Greece
Eftihia Sbarouni1, Vassilis Voudris, Panagiota Georgiadou
1Second Division of Interventional Cardiology, Onassis Cardiac Surgery Center, Athens, Greece.
Insights
High heart rates (HR) persist in many stable coronary artery disease (CAD) patients despite treatment. Optimizing beta-blocker and other HR-lowering agent use could improve control in this population.
Area of Science:
- Cardiology
- Clinical Practice
- Pharmacology
Background:
- Heart rate (HR) is a critical prognostic factor in coronary artery disease (CAD).
- Limited contemporary data exists on HR management and beta-blocker use in CAD patients.
Purpose of the Study:
- To investigate heart rate levels and beta-blocker utilization in stable CAD patients within Greece.
- To identify factors associated with elevated heart rates in this cohort.
Main Methods:
- Analysis of the CLARIFY international registry data, including 559 stable CAD patients from Greece.
- Prospective, observational, longitudinal study design.
- HR measured by pulse and electrocardiogram; beta-blocker use recorded.
Main Results:
- Mean HR was approximately 68 bpm, with 42.8% of patients exhibiting HR ≥ 70 bpm.
- Beta-blockers were prescribed to 74.2% of patients.
- Elevated HR was linked to inactivity, higher blood pressure, and comorbidities like COPD and carotid artery disease.
Conclusions:
- A significant proportion of Greek stable CAD patients have elevated HR despite current therapies.
- Opportunities exist to improve HR control through increased beta-blocker prescription and dose optimization.
- Further utilization and titration of other HR-lowering medications are recommended.
Introduction:
Heart rate (HR) is a strong prognostic indicator in patients with coronary artery disease (CAD). However, there is only limited evidence on HR and the use of b-blockers in patients with CAD in contemporary clinical practice.
Methods:
CLARIFY is an international, prospective, observational, longitudinal registry of outpatients with stable CAD, defined as prior myocardial infarction or revascularization procedure, evidence of coronary stenosis >50%, or chest pain associated with proven myocardial ischemia. A total of 33,283 patients from 45 countries were enrolled between November 2009 and July 2010; of these, 559 patients were enrolled in Greece (age 62.3 ± 10.6 years, 84.44% men).
Results:
HR measured by pulse was 68.3 ± 10.2 bpm and by electrocardiogram 67.6 ± 10.9, with an excellent correlation (r=0.91, p<0.001). Overall, 42.8% had HR70 bpm. B-blockers were prescribed in 74.2% of patients. Resting HR by pulse on b-blocker was 67.8 bpm and without b-blocker 69.6 bpm (p=0.069). HR70 bpm was independently associated with a lack of physical activity, higher systolic blood pressure, and a higher prevalence of asthma or chronic obstructive pulmonary disease and carotid artery disease.
Conclusion:
Despite the use of HR lowering agents, the percentage of patients with HR70 bpm was high. It is likely that we can further improve HR control in Greek patients with stable CAD by both increasing the prescription of b-blockers and up-titrating their dose, as well as by using and up-titrating other available HR lowering agents.
