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Resting heart rate in ambulatory heart failure with reduced ejection fraction treated with beta‐blockers

AIMS: Current guidelines recommend beta‐blocker therapy in chronic heart failure with reduced ejection fraction (HFrEF) titrated according to tolerated target dose. The efficiency of this strategy to obtain adequate heart rate (HR) control remains unclear in clinical practice. The aim of this study...

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Autores principales: Varian, Kenneth D., Ji, Xinge, Grodin, Justin L., Verbrugge, Frederik H., Milinovich, Alex, Kattan, Michael W., Tang, W.H. Wilson
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7524238/
https://www.ncbi.nlm.nih.gov/pubmed/32757485
http://dx.doi.org/10.1002/ehf2.12931
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author Varian, Kenneth D.
Ji, Xinge
Grodin, Justin L.
Verbrugge, Frederik H.
Milinovich, Alex
Kattan, Michael W.
Tang, W.H. Wilson
author_facet Varian, Kenneth D.
Ji, Xinge
Grodin, Justin L.
Verbrugge, Frederik H.
Milinovich, Alex
Kattan, Michael W.
Tang, W.H. Wilson
author_sort Varian, Kenneth D.
collection PubMed
description AIMS: Current guidelines recommend beta‐blocker therapy in chronic heart failure with reduced ejection fraction (HFrEF) titrated according to tolerated target dose. The efficiency of this strategy to obtain adequate heart rate (HR) control remains unclear in clinical practice. The aim of this study was to determine, in a real‐world setting, the proportion of HFrEF patients who fail to achieve beta‐blocker target doses, whether target doses of beta‐blockers have a relationship with the adequacy in reducing resting HR over time. METHODS AND RESULTS: Beta‐blocker dose and resting HR of consecutive ambulatory patients with a diagnosis of HFrEF (ejection fraction ≤ 35%) in sinus rhythm were reviewed at the first outpatient contact in the Cleveland Clinic Health System from the year 2000 to 2015. Patients who did not receive beta‐blocker therapy, have congenital heart disease and hypertrophic cardiomyopathy, were not in sinus rhythm, or have a history of heart transplant were excluded. Patients were followed up until their last known visit at the Cleveland Clinic. Median resting HR was 71 b.p.m. [inter‐quartile range (IQR) 60–84 b.p.m.] in 8041 patients (median age 65; 68% male) with 67% on carvedilol, 32% on metoprolol succinate, and 1% on bisoprolol. In 3674 subjects (56%), resting HR was ≥70 b.p.m. At final follow‐up after a median of 21 months (IQR 0.1–7.2 years), resting HR was 72 b.p.m. (IQR 60–84 b.p.m.) in the subset of patients with persistently low ejection fraction ≤ 35%. HR ≥ 70 b.p.m. was observed in 55% of this group. Beta‐blocker target dose was achieved in 19%, 5%, and 15% of those receiving carvedilol, metoprolol succinate, and bisoprolol, respectively. In the subset of patients who experienced beta‐blocker up‐titration, reduced mortality or hospitalization due to heart failure was observed in patients who experienced the lowest HR after titration. CONCLUSIONS: In our single‐centre experience, the majority of patients with chronic HFrEF treated with beta‐blocker therapy did not achieve target doses over time, and a substantial proportion had inadequate control of resting HR. There was no relationship between achieved beta‐blocker target dose and resting HR control.
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spelling pubmed-75242382020-10-02 Resting heart rate in ambulatory heart failure with reduced ejection fraction treated with beta‐blockers Varian, Kenneth D. Ji, Xinge Grodin, Justin L. Verbrugge, Frederik H. Milinovich, Alex Kattan, Michael W. Tang, W.H. Wilson ESC Heart Fail Original Research Articles AIMS: Current guidelines recommend beta‐blocker therapy in chronic heart failure with reduced ejection fraction (HFrEF) titrated according to tolerated target dose. The efficiency of this strategy to obtain adequate heart rate (HR) control remains unclear in clinical practice. The aim of this study was to determine, in a real‐world setting, the proportion of HFrEF patients who fail to achieve beta‐blocker target doses, whether target doses of beta‐blockers have a relationship with the adequacy in reducing resting HR over time. METHODS AND RESULTS: Beta‐blocker dose and resting HR of consecutive ambulatory patients with a diagnosis of HFrEF (ejection fraction ≤ 35%) in sinus rhythm were reviewed at the first outpatient contact in the Cleveland Clinic Health System from the year 2000 to 2015. Patients who did not receive beta‐blocker therapy, have congenital heart disease and hypertrophic cardiomyopathy, were not in sinus rhythm, or have a history of heart transplant were excluded. Patients were followed up until their last known visit at the Cleveland Clinic. Median resting HR was 71 b.p.m. [inter‐quartile range (IQR) 60–84 b.p.m.] in 8041 patients (median age 65; 68% male) with 67% on carvedilol, 32% on metoprolol succinate, and 1% on bisoprolol. In 3674 subjects (56%), resting HR was ≥70 b.p.m. At final follow‐up after a median of 21 months (IQR 0.1–7.2 years), resting HR was 72 b.p.m. (IQR 60–84 b.p.m.) in the subset of patients with persistently low ejection fraction ≤ 35%. HR ≥ 70 b.p.m. was observed in 55% of this group. Beta‐blocker target dose was achieved in 19%, 5%, and 15% of those receiving carvedilol, metoprolol succinate, and bisoprolol, respectively. In the subset of patients who experienced beta‐blocker up‐titration, reduced mortality or hospitalization due to heart failure was observed in patients who experienced the lowest HR after titration. CONCLUSIONS: In our single‐centre experience, the majority of patients with chronic HFrEF treated with beta‐blocker therapy did not achieve target doses over time, and a substantial proportion had inadequate control of resting HR. There was no relationship between achieved beta‐blocker target dose and resting HR control. John Wiley and Sons Inc. 2020-08-05 /pmc/articles/PMC7524238/ /pubmed/32757485 http://dx.doi.org/10.1002/ehf2.12931 Text en © 2020 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
spellingShingle Original Research Articles
Varian, Kenneth D.
Ji, Xinge
Grodin, Justin L.
Verbrugge, Frederik H.
Milinovich, Alex
Kattan, Michael W.
Tang, W.H. Wilson
Resting heart rate in ambulatory heart failure with reduced ejection fraction treated with beta‐blockers
title Resting heart rate in ambulatory heart failure with reduced ejection fraction treated with beta‐blockers
title_full Resting heart rate in ambulatory heart failure with reduced ejection fraction treated with beta‐blockers
title_fullStr Resting heart rate in ambulatory heart failure with reduced ejection fraction treated with beta‐blockers
title_full_unstemmed Resting heart rate in ambulatory heart failure with reduced ejection fraction treated with beta‐blockers
title_short Resting heart rate in ambulatory heart failure with reduced ejection fraction treated with beta‐blockers
title_sort resting heart rate in ambulatory heart failure with reduced ejection fraction treated with beta‐blockers
topic Original Research Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7524238/
https://www.ncbi.nlm.nih.gov/pubmed/32757485
http://dx.doi.org/10.1002/ehf2.12931
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