Heart rate as a prognostic marker and therapeutic target in acute and chronic heart failure

Area of Science:

• Cardiology
• Pharmacology

Background:

• Increased heart rate (HR) is a significant prognostic indicator linked to higher mortality in various cardiac conditions.
• In heart failure (HF), HR is a key therapeutic target, especially in the chronic phase, though beta-blocker therapy can be limited by patient intolerance or hemodynamics.

Purpose of the Study:

• To review the role of HR as a prognostic biomarker and therapeutic target in scenarios beyond chronic HF.
• To update the understanding of HR management in patients with coexisting atrial fibrillation (AF), HF with preserved ejection fraction (HFpEF), and acute HF.

Main Methods:

• Review of preliminary studies and case reports on ivabradine in acute HF.
• Presentation of recent findings on HR reduction with ivabradine in HFpEF.
• Analysis of data from large registries and trials on the prognostic impact of HR in acute HF (sinus rhythm and AF).

Main Results:

• Ivabradine has shown potential in improving outcomes in specific HF populations.
• HR reduction may offer benefits in HFpEF, with ongoing research.
• Prognostic impact of HR varies; only patients in sinus rhythm appear to benefit from HR reduction in acute HF.

Conclusions:

• HR remains a critical prognostic marker and therapeutic target in cardiovascular disease.
• Further research is needed to define the role of HR reduction in diverse HF phenotypes, including AF and acute settings.
• Current evidence suggests sinus rhythm patients with acute HF may benefit most from HR-lowering interventions.