Adherence to optimal heart rate control in heart failure with reduced ejection fraction: insight from a survey of heart rate in heart failure in Sweden (HR-HF study)

Abstract

IntroductionDespite that heart rate (HR) control is one of the guideline-recommended treatment goals for heart failure (HF) patients, implementation has been painstakingly slow. Therefore, it would be important to identify patients who have not yet achieved their target heart rates and assess possible underlying reasons as to why the target rates are not met.Materials and methodsThe survey of HR in patients with HF in Sweden (HR-HF survey) is an investigator-initiated, prospective, multicenter, observational longitudinal study designed to investigate the state of the art in the control of HR in HF and to explore potential underlying mechanisms for suboptimal HR control with focus on awareness of and adherence to guidelines for HR control among physicians who focus on the contributing role of beta-blockers (BBs).ResultsIn 734 HF patients the mean HR was 68 ± 12 beats per minute (bpm) (37.2% of the patients had a HR >70 bpm). Patients with HF with reduced ejection fraction (HFrEF) (n = 425) had the highest HR (70 ± 13 bpm, with 42% >70 bpm), followed by HF with preserved ejection fraction and HF with mid-range ejection fraction. Atrial fibrillation, irrespective of HF type, had higher HR than sinus rhythm. A similar pattern was observed with BB treatment. Moreover, non-achievement of the recommended target HR (<70 bpm) in HFrEF and sinus rhythm was unrelated to age, sex, cardiovascular risk factors, cardiovascular diseases, and comorbidities, but was related to EF and the clinical decision of the physician. Approximately 50% of the physicians considered a HR of >70 bpm optimal and an equal number considered a HR of >70 bpm too high, but without recommending further action. Furthermore, suboptimal HR control cannot be attributed to the use of BBs because there was neither a difference in use of BBs nor an interaction with BBs for HR >70 bpm compared with HR <70 bpm.ConclusionSuboptimal control of HR was noted in HFrEF with sinus rhythm, which appeared to be attributable to physician decision making rather than to the use of BBs. Therefore, our results underline the need for greater attention to HR control in patients with HFrEF and sinus rhythm and thus a potential for improved HF care.

Association between hypo- and hyperkalemia and outcome in acute heart failure patients: the role of medications

“…We acknowledge that adhesion to guidelines regarding treatment of heart failure was low, especially regarding the use of B-blockers (only 40% of patients were treated with B-blockers) [23]. This observation was similar to recently published low adherence to guidelines in heart failure patients [24][25][26]. Potassium intake was not available in this registry.…”

Long-term effects of device-guided slow breathing in stable heart failure patients with reduced ejection fraction

“…Amongst behavioural interventions, slowing spontaneous breathing rate below 10 breaths/min has the potential to favourably affect CV regulation [39–42]. The use of slow breathing (SLOWB) technique has been shown to reduce dyspnoea, improve oxygen saturation and exercise tolerance in HF patients, acutely increase baroreflex gain and stability in patients with CV disease and a risk for sudden death [42–45].…”

“…Amongst behavioural interventions, slowing spontaneous breathing rate below 10 breaths/min has the potential to favourably affect CV regulation [ 39 – 42 ]. The use of slow breathing (SLOWB) technique has been shown to reduce dyspnoea, improve oxygen saturation and exercise tolerance in HF patients, acutely increase baroreflex gain and stability in patients with CV disease and a risk for sudden death [ 42 – 45 ]. Data from pilot studies of patients with systolic chronic HF have demonstrated the feasibility of device-guided SLOWB pacing with the use of the RESPeRATE, improvements in NYHA class and left ventricle ejection fraction (LVEF), reductions in pulmonary pressure [ 46 , 47 ] and breathlessness [ 48 ].…”

Natriuretic and Inflammatory Biomarkers as Risk Predictors of Heart Failure in Middle-Aged Men From the General Population: A 21-Year Follow-Up

“…64 However, recent studies demonstrate similar prevalence between these two HF phenotypes. 51,65 Few studies have compared the relative impact of non-cardiac comorbidities on prognosis in patients with HFrEF compared to HFpEF and available results have been inconsistent. 61,[66][67][68][69][70]…”