Relationships Among Heart Rate, β-Blocker Dosage, and Prognosis in Patients With Coronary Artery Disease in a Real-World Database Using a Multimodal Data Acquisition System
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Updated: Aug 26, 2025
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Published on: June 27, 2025
Yusuke Oba1, Tomoyuki Kabutoya1, Takahide Kohro1
1Jichi Medical University School of Medicine.
Insights
Higher heart rates (HR) above 75 beats/min are linked to worse outcomes in coronary artery disease (CAD) patients. Optimal beta-blocker (BB) dosing is crucial, especially for acute coronary syndrome (ACS) patients.
Area of Science:
- Cardiology
- Clinical Research
- Pharmacology
Background:
- Optimal heart rate (HR) and beta-blocker (BB) dosing in coronary artery disease (CAD) patients remain unclear.
- Multimodal data acquisition systems offer potential for clarifying these relationships.
Purpose of the Study:
- To investigate the association between HR, BB dose, and prognosis in CAD patients.
- To determine optimal HR and BB strategies for improved patient outcomes.
Main Methods:
- Analysis of 8,744 CAD patients from 6 university hospitals and the National Cerebral and Cardiovascular Center.
- Patients stratified into quartiles based on HR at discharge (Q1: <60, Q2: 60-66, Q3: 67-74, Q4: ≥75 beats/min).
- Evaluation of major adverse cardiac and cerebral events (MACCE) in relation to HR and BB dosage.
Main Results:
- Patients in Q4 (HR ≥75 beats/min) exhibited significantly higher MACCE incidence compared to Q1 in both ACS and chronic coronary syndrome (CCS) groups.
- Low-dose BB administration was associated with increased MACCE in the ACS group (HR 1.41, P=0.012).
- No significant association between low-dose BBs and MACCE was found in the CCS group after covariate adjustment.
Conclusions:
- A heart rate of 75 beats/min or higher is associated with adverse outcomes in both ACS and CCS patients.
- Beta-blocker therapy requires careful consideration of dosage, particularly in ACS patients, to mitigate risks.
Background:
The optimal heart rate (HR) and optimal dose of β-blockers (BBs) in patients with coronary artery disease (CAD) have been unclear. We sought to clarify the relationships among HR, BB dose, and prognosis in patients with CAD using a multimodal data acquisition system.
Methods And Results:
We evaluated the data for 8,744 CAD patients who underwent cardiac catheterization from 6 university hospitals and the National Cerebral and Cardiovascular Center and who were registered using the Clinical Deep Data Accumulation System. Patients were divided into quartile groups based on their HR at discharge: Q1 (HR <60 beats/min), Q2 (HR 60-66 beats/min), Q3 (HR 67-74 beats/min), and Q4 (HR ≥75 beats/min). Among patients with acute coronary syndrome (ACS) and patients with chronic coronary syndrome (CCS), those in Q4 (HR ≥75 beats/min) had a significantly greater incidence of major adverse cardiac and cerebral events (MACCE) compared with those in Q1 (ACS patients: hazard ratio 1.65, P=0.001; CCS patients: hazard ratio 1.45, P=0.019). Regarding the use of BBs (n=4,964), low-dose administration was significantly associated with MACCE in the ACS group (hazard ratio 1.41, P=0.012), but not in patients with CCS after adjustment for covariates.
Conclusions:
HR ≥75 beats/min was associated with worse outcomes in patients with CCS or ACS.
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