β-Blockade in Heart Failure With Reduced Ejection Fraction: Does Heart Rate Control Influence Readmissions?

Area of Science:

• Cardiology
• Clinical Pharmacology

Background:

• Elevated resting heart rate (HR) is a risk factor for adverse cardiovascular outcomes and hospital readmissions in patients with heart failure with reduced ejection fraction (HF rEF).
• Beta-blockers are recommended for HF rEF due to their mortality benefit, with titration to maximum tolerated dose as the goal, not a specific HR target.

Purpose of the Study:

• To evaluate the effect of achieving optimal HR control (<70 bpm) prior to hospital discharge on 30-day hospital readmissions in HF rEF patients treated with beta-blockade.

Main Methods:

• Retrospective study analyzing data from 225 patients with acute on chronic HF rEF admitted between 2013 and 2015 across five urban hospitals.
• Patients were identified using ICD-9 codes for HF rEF.

Main Results:

• Only 20% of patients achieved optimal HR control (<70 bpm) by discharge.
• Beta-blocker titration was infrequent (15% of patients).
• Readmission rates at 30 days were similar for patients with HR <70 bpm (9%) versus HR ≥70 bpm (11%), with no significant difference in ED visits.

Conclusions:

• Similar readmission rates were observed in HF rEF patients regardless of achieving optimal HR control, indicating potential limitations of HR as a sole discharge metric.
• Beta-blocker dosing in HF rEF patients frequently remains below guideline-recommended target doses.
• Inpatient clinicians have opportunities to optimize beta-blocker therapy to improve HR control in HF rEF patients.