Heart rate and its reduction in chronic heart failure and beyond

Area of Science:

• Cardiology
• Clinical Research

Background:

• Elevated heart rate (HR) is a significant predictor of adverse cardiovascular outcomes across various conditions, including heart failure, coronary disease, and other systemic diseases.
• In the general population and cardiovascular disease patients, increased HR over 70 bpm is linked to higher mortality risk.
• In chronic heart failure with reduced ejection fraction (HFrEF), HR >70 bpm increases hospitalization risk, and >75 bpm elevates cardiovascular death risk.

Purpose of the Study:

• To evaluate the impact of heart rate reduction on cardiovascular outcomes in patients with HFrEF.
• To determine if heart rate is a modifiable risk factor in heart failure.

Main Methods:

• The Systolic Heart Failure Treatment with the If Inhibitor Ivabradine Trial (SHIFT) was a placebo-controlled study.
• Ivabradine was used to reduce HR in patients with HFrEF in sinus rhythm.

Main Results:

• Reducing HR by 11 bpm with ivabradine significantly decreased the composite endpoint of cardiovascular death and hospitalization for worsening heart failure.
• Ivabradine demonstrated benefits regardless of patient age, diabetes status, baseline blood pressure, or heart failure severity.
• In stable coronary disease, HR reduction with ivabradine did not improve outcomes.

Conclusions:

• Heart rate is a modifiable risk factor in heart failure, and its reduction with ivabradine improves clinical outcomes.
• The role of HR reduction in other diseases remains to be investigated, warranting future studies to define HR as a potential therapeutic target beyond heart failure.