Prescribing Patterns to Optimize Heart Rate

Dierckx, Riet; Cleland, John G.F.; Parsons, Sunaina; Putzu, Paola; Pellicori, Pierpaolo; Dicken, Benjamin; Boyalla, Vennela; Clark, Andrew L.

doi:10.1016/j.jchf.2014.11.003

Cited by 24 publications

(11 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Of 1000 consecutive clinic visits at a HF-specialty clinic in Kingston-upon-Hull, United Kingdom, 17% of patients had HFrEF and sinus rhythm. 10 In contrast to our study and the above data from Germany, a smaller proportion of these patients, <20%, had elevated HRs during serial follow-up visits. However, in that study, the authors highlighted that more than half of the patients with opportunities for titration of beta-blockers or ivabradine were missed and no actions were taken to address the elevated HR at clinic visits.…”

Section: Discussioncontrasting

confidence: 99%

“…6 Previous evaluations of HR in patients with HFrEF in routine practice focused on patients hospitalized with HF 4, 5, 7 or were performed outside the United States. 8–10 In addition, there are limited data evaluating the association of HR ≥70 bpm with future medical costs. We aimed to describe the proportion of patients at a large tertiary care center in the United States with HRs ≥70 bpm and associated outcomes including mortality, hospitalizations, and costs.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Relation of Elevated Heart Rate in Patients With Heart Failure With Reduced Ejection Fraction to One-Year Outcomes and Costs

DeVore

Schulte

Mentz

et al. 2016

The American Journal of Cardiology

View full text Add to dashboard Cite

There are limited data describing outcomes associated with an elevated heart rate in patients with heart failure with reduced ejection fraction (HFrEF) in routine clinical practice. We identified patients with HFrEF at Duke University Hospital undergoing echocardiograms and heart rate assessments without paced rhythms or atrial fibrillation. Outcomes (all-cause mortality or hospitalization and medical costs per day alive) were assessed using electronic medical records, hospital cost accounting data, and national death records. Patients were stratified by heart rate (<70, ≥70 bpm) and compared using generalized linear models specified with gamma error distributions and log-links for costs and proportional hazard models for mortality/hospitalization. Of 722 eligible patients, 582 (81%) were treated with beta-blockers. The median heart rate was 81 bpm (25th, 75th percentile 69–96) and 527 (73%) had a heart rate ≥70 bpm. After multivariable adjustment, a heart rate ≥70 bpm was associated with increased 1-year all-cause mortality or hospitalization, hazard ratio 1.37 (95% CI 1.07, 1.75) and increased medical costs per day alive, cost ratio 2.03 (95% CI 1.53, 2.69). In conclusion, at a large tertiary care center, despite broad use of beta-blockers, a heart rate ≥70 bpm was observed in 73% of patients with HFrEF and associated with worse 1-year outcomes and increased direct medical costs per day alive.

show abstract

Section: Discussioncontrasting

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Relation of Elevated Heart Rate in Patients With Heart Failure With Reduced Ejection Fraction to One-Year Outcomes and Costs

DeVore

Schulte

Mentz

et al. 2016

The American Journal of Cardiology

View full text Add to dashboard Cite

show abstract

“…However, recent trials and registries indicate that among patients with heart failure and LVEF ≤35%, even when treated with β-blockers, resting heart rate exceeds 70 bpm in a substantial proportion of patients [68,72,73,74]. In order to improve outcomes, these patients may need bradycardic drugs in addition to β-adrenergic blocking agents.…”

Section: Concluding Remarks and Therapeutic Considerationsmentioning

confidence: 99%

Heart Rate, Life Expectancy and the Cardiovascular System: Therapeutic Considerations

Boudoulas¹,

Borer²,

Boudoulas³

2015

Cardiology

1,247

View full text Add to dashboard Cite

It has long been known that life span is inversely related to resting heart rate in most organisms. This association between heart rate and survival has been attributed to the metabolic rate, which is greater in smaller animals and is directly associated with heart rate. Studies have shown that heart rate is related to survival in apparently healthy individuals and in patients with different underlying cardiovascular diseases. A decrease in heart rate due to therapeutic interventions may result in an increase in survival. However, there are many factors regulating heart rate, and it is quite plausible that these may independently affect life expectancy. Nonetheless, a fast heart rate itself affects the cardiovascular system in multiple ways (it increases ventricular work, myocardial oxygen consumption, endothelial stress, aortic/arterial stiffness, decreases myocardial oxygen supply, other) which, in turn, may affect survival. In this brief review, the effects of heart rate on the heart, arterial system and survival will be discussed.

show abstract

“…However, for newer drugs, such as ivabradine, implementation has been slower. For instance, Dierckx et al reported that of patients with HFrEF, 94% were treated with BBs and only 4% were taking ivabradine [ 9 ]. One possible reason is physician-related factors, such as lack of awareness of and/or adherence to optimal heart rate (HR) control as part of the treatment goal in HFrEF and sinus rhythm.…”

Section: Introductionmentioning

confidence: 99%

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)

Ahrenmark

Berglund

et al. 2017

Clin Res Cardiol

View full text Add to dashboard Cite

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.

show abstract

Prescribing Patterns to Optimize Heart Rate

Abstract: Among patients with LVEFs of ≤35%, most are treated with BBs and have a heart rate at rest of <70 beats/min; 12% of these patients might be eligible for ivabradine.

Cited by 24 publications

References 26 publications

Relation of Elevated Heart Rate in Patients With Heart Failure With Reduced Ejection Fraction to One-Year Outcomes and Costs

Relation of Elevated Heart Rate in Patients With Heart Failure With Reduced Ejection Fraction to One-Year Outcomes and Costs

Heart Rate, Life Expectancy and the Cardiovascular System: Therapeutic Considerations

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)

Contact Info

Product

Resources

About