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Does heart rate really matter to patients with heart failure?
Robert J H Miller1, Jonathan G Howlett
1Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada.
Current Opinion in Cardiology
|December 17, 2016
Summary
Lowering heart rate (HR) with ivabradine improves outcomes in heart failure with reduced ejection fraction (HFrEF). Optimal HR targets remain unclear for other heart conditions like HFpEF and atrial fibrillation.
Area of Science:
- Cardiology
- Clinical Medicine
- Pharmacology
Background:
- Heart rate (HR) and rhythm are crucial for identifying disease progression and guiding therapy.
- HR assessment informs treatment selection and response monitoring in various cardiovascular conditions.
Purpose of the Study:
- To review the role of HR management in cardiovascular diseases.
- To evaluate the impact of HR lowering agents, specifically ivabradine, on patient outcomes.
- To identify current knowledge gaps in HR control strategies for specific patient populations.
Main Methods:
- Review of clinical studies and guidelines on HR management.
- Analysis of data from trials investigating HR lowering agents like ivabradine.
- Synthesis of evidence regarding HR targets in heart failure with reduced ejection fraction (HFrEF), heart failure with preserved ejection fraction (HFpEF), and arrhythmias.
Main Results:
- Ivabradine improves outcomes in HFrEF patients with elevated HR (>70 bpm) despite beta-blockade.
- Coadministration of ivabradine and beta-blockers may enhance symptom control and HR management.
- Optimal HR targets are not established for HFpEF, paced rhythms, or atrial fibrillation, with a general recommendation of 60-100 bpm at rest.
Conclusions:
- HR remains a critical vital sign and a therapeutic target in HFrEF.
- Further research is necessary to define optimal HR targets and refine treatment strategies for patients with HFpEF, paced rhythms, and atrial fibrillation.
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