Aggressive Therapy Doesn’t Always Lower Heart Rate in Heart Failure

BOSTON — A single heart rate (HR) measurement could be important in determining future prognosis of chronic heart failure with reduced ejection fraction (HFrEF).

Still, according to a recent article in the American Journal of Cardiology, the importance of elevated HR across serial assessment is uncertain, particularly with well-applied guideline-directed medical therapy (GDMT) with beta blockers (BBs).1

A study team, led by Massachusetts General Hospital and including participation from the VA Connecticut Healthcare System in West Haven, conducted a post hoc analysis of 129 patients with chronic HFrEF in sinus rhythm.

The patients had aggressive medication titration over 10.6 months, and HR and BB use were assessed at each visit, with an average of six visits per patient. In addition, all-cause mortality was assessed.

Study authors report that, at baseline, 62.8% of the subjects had HR 70 beats/min or greater, while 31% had high HR despite being on 50% or greater of GDMT BB dose.

Results indicate that, at the final visit, 30.4% of the subjects still had high HR despite achieving 50% or greater target BB dose.

No significant baseline differences in demographics or BB doses were detected in patients with HR less than 70 vs. HR of 70 beats/min or greater. In an adjusted model in which HR was treated as time-dependent covariate, an increase in HR of 10 beats/min was associated with an increased hazard of all-cause mortality during follow-up, for an adjusted hazard ratio per 10 beats/min of 2.46.

“In conclusion, in well-managed patients with HFrEF, high HR was frequent even after aggressive medication titration, and often despite being on at least 50% of GDMT BB dose,” the researchers concluded. “An increase in HR was associated with worse clinical outcomes

Ibrahim NE, Januzzi JL, Roubideaux DJ, Gandhi PU, Gaggin HK. Serial Heart Rates, Guideline-Directed Beta Blocker Use, and Outcomes in Patients With Chronic Heart Failure With Reduced Ejection Fraction. Am J Cardiol. 2017 Jun 15. pii:S0002-9149(17)30952-9. doi: 10.1016/j.amjcard.2017.05.052.[Epub ahead of print] PubMed PMID: 28728744.

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