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Author Spotlight: Investigating HR-Dependent Cardiac Function in Mouse Models Through a Novel Atrial-Pacing Approach
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Achieving Guideline-Directed Heart Rate ControlEarly Posthospitalization.

Carsten G Jungbauer1, Lars S Maier1, Kikuo Emoto2

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Many heart failure patients struggle to reach target heart rates (HR) with beta blockers (BB) post-hospitalization. Continuous monitoring with a wearable cardioverter defibrillator (WCD) can help guide treatment adjustments for better outcomes.

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Area of Science:

  • Cardiology
  • Medical Devices
  • Digital Health

Background:

  • Heart failure (HF) treatment guidelines emphasize beta blocker (BB) titration for heart rate (HR) control.
  • Target resting HR <70 bpm is associated with improved clinical outcomes in HF patients.
  • Effective HR management is crucial for optimizing BB therapy post-hospitalization.

Purpose of the Study:

  • To evaluate the feasibility of achieving guideline-directed HR control in early post-hospitalization HF patients using a wearable cardioverter defibrillator (WCD).
  • To assess the WCD's capability in monitoring HR at rest and during activity to guide clinical decisions.
  • To determine if WCD monitoring aids in meeting target HR goals for HF management.

Main Methods:

  • Continuous HR data was collected from 1,353 HF patients wearing a WCD for at least 5 weeks between 2015-2017.
  • HR was analyzed at rest (daytime and nighttime) and during activities of daily living (ADL).
  • Over 643,000 activity episodes were analyzed to assess HR trends and target achievement.

Main Results:

  • Average daytime resting HR decreased from 72.5 to 69.0 bpm, and nighttime HR from 68.1 to 64.3 bpm by the end of WCD use (p <0.0001).
  • Despite improvements, 43% of patients maintained an average daytime resting HR ≥70 bpm in the final week of monitoring.
  • No significant change in peak activity HR was observed (93.6 vs 94.1 bpm, p=0.23), with many patients experiencing elevated HR during ADL (≥100 bpm in 31%, ≥110 bpm in 14%, ≥120 bpm in 6%).

Conclusions:

  • A significant proportion of HF patients (43%) do not achieve guideline-directed resting HR targets months after discharge, suggesting suboptimal BB management.
  • Elevated HR during daily activities may also indicate inadequate therapeutic control.
  • Continuous remote HR monitoring via WCD offers a potential strategy to optimize BB titration and improve clinical outcomes in HF patients.