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[Heart rate control in chronic heart failure patients received cardiovascular implantable electronic device therapy:
1Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang 110016, China.
Insights
Optimizing heart rate control in chronic heart failure (CHF) patients with cardiovascular implantable electronic devices (CIEDs) is crucial. Adjusting medications like beta-blockers and ivabradine significantly improves resting heart rate (RHR) in these patients.
Area of Science:
- Cardiology
- Clinical Medicine
- Pharmacology
Background:
- Chronic heart failure (CHF) patients often have suboptimal heart rate control despite receiving cardiovascular implantable electronic device (CIED) therapy.
- Resting heart rate (RHR) management is critical for improving outcomes in heart failure with reduced left ventricular ejection fraction (HFrEF).
Purpose of the Study:
- To investigate the current heart rate control status in CHF patients treated with CIEDs.
- To evaluate the efficacy of optimized medication adjustments, specifically beta-receptor blockers and ivabradine, in achieving target RHR.
Main Methods:
- A prospective study involving 150 HFrEF patients who received CIEDs between January 2012 and January 2017.
- Baseline RHR and medication use were recorded; patients with RHR > 70 bpm had their beta-blocker dosage increased or ivabradine added.
- RHR was reassessed during follow-up after medication optimization.
Main Results:
- At baseline, the average RHR was 80.6±11.9 bpm, with only 27.3% of patients achieving RHR < 70 bpm.
- Up-titration of beta-blockers increased the proportion of patients with RHR < 70 bpm to 70.0% (P<0.001).
- Subsequent addition of ivabradine in non-responders further improved RHR control, achieving < 70 bpm in 98.7% of all patients (P<0.001).
Conclusions:
- Heart rate in CHF patients with CIEDs is frequently not optimally controlled.
- Individualized up-titration of beta-receptor blockers and the judicious use of ivabradine are effective strategies for optimizing RHR in this population.
Abstract:
Objective: To investigate the heart rate control situation of chronic heart failure (CHF) patients who received cardiovascular implantable electronic device (CIED) therapy, and to assess the heart rate control efficacy by optimized medication adjustment. Methods: We performed a perspective study in heart failure with reduced left ventricular ejection fraction (HFrEF) patients who received CIED according to guideline recommendations, patients were enrolled from January 2012 to January 2017. Resting heart rate (RHR) recorded by electrocardiogram after 10 minutes' rest and medication usage within 1 month were recorded at baseline. RHR less than 70 beats per minute (bpm) was regarded as well controlled. β-receptor blockers and (or) ivabradine would be added in patients whose RHR were over 70 bpm. RHR after optimized medication adjustment was recorded during follow-up period. Results: One hundred and fifty patients were included in this study with average RHR (80.6±11.9) bpm. RHR was<70 bpm in 27.3% (41/150) patients at baseline and β-receptor blockers was underused in 80.7% patients (88/109) whose RHR was>70 bpm. The overall RHR decreased to (73.1±10.4) bpm and percent of patients with RHR<70 bpm increased to 70.0% (105/150) after up-titration of β-receptor blockers compared to baseline (χ2=52.958, P<0.001). Ivabradine was added in the rest 45 patients and RHR was<70 bpm in 43 out of 45 patients after ivabradine use. The overall RHR decreased to (67.1±2.7) bpm and percent of RHR<70 bpm significantly increased to 98.7% (148/150) (χ2=44.504, P<0.001 vs. up-titration of β-receptor blockers only). Conclusion: RHR in CHF patients who received CIED therapy is not ideally controlled in this patient cohort, individual up-titration ofβ-receptor blockers and ivabradine use may help to optimize RHR in these patients.
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