Heart rate control and its predictors in patients with heart failure and sinus rhythm. Data from the European Society of Cardiology Long-Term Registry

Abstract

Background: Higher resting heart rate (HR) in patients with heart failure (HF) and sinus rhythm (SR) is associated with increased mortality. In patients hospitalized for HF, the aim herein, was to assess the use and dosage of guideline-recommended HR lowering medications, HR control at discharge and predictors of HR control.

Methods: In the present study, were Polish participants of the European Society of Cardiology HF Long-Term (ESC-HF-LT) Registry. Those selected were hospitalized for HF, with reduced ejection fraction (HFrEF) and SR at discharge (n = 236). The patients were divided in two groups ( < 70 and ≥ 70 bpm). Logistic regression was used to identify the predictors of HR ≥ 70 bpm.

Results: Of patients with HFrEF and SR, 59% had HR ≥ 70 bpm at hospital discharge. At discharge, 96% and only 0.5% of the patients with HFrEF and SR received beta-blocker and ivabradine, respectively. In the HF groups < 70 and ≥ 70 bpm, only 11% and 4% of patients received beta-blocker target doses, respectively. There was no difference in the use of other guideline-recommended medications. Age, New York Heart Association class, HR on admission and lack of HR lowering medications were predictors of discharge HR ≥ 70 bpm.

Conclusions: Heart rate control after hospitalization for HFrEF is unsatisfactory, which may be attributed to suboptimal doses of beta-blockers, and negligence in use other HR lowering drugs (including ivabradine).

Keywords: acute heart failure; beta blocker; hospitalization; ivabradine; sinus rhythm; target heart rate.

Figure 1

Flow chart of patient enrollment in the current analysis; LVEF — left ventricular ejection fraction; HFrEF — heart failure with reduced LVEF; HFmrEF — heart failure with mildly reduced LVEF; HFpEF — heart failure with preserved LVEF; HR — heart rate; SR — sinus rhythm.

Figure 2

Distribution of heart rate at discharge in heart failure patients in sinus rhythm participating in the European Society of Cardiology Heart Failure Long-Term Registry (ESC-HF-LT) (A) and European Society of Cardiology Heart Failure Pilot Registry (ESC-HF Pilot survey) (B). Red line separates the graph into two heart rate groups: < 70 bmp and ≥ 70 bpm.