PMID- 20462892
OWN - NLM
STAT- MEDLINE
DCOM- 20101101
LR  - 20101015
IS  - 1940-1574 (Electronic)
IS  - 0003-3197 (Linking)
VI  - 61
IP  - 8
DP  - 2010 Nov
TI  - Heart rate control in an unselected consecutive population of outpatients with 
      stable coronary artery disease: Analysis of the CARDIf Study Cohort.
PG  - 763-7
LID - 10.1177/0003319710369102 [doi]
AB  - BACKGROUND: Despite increasing pharmacological and mechanical treatment options, 
      coronary artery disease (CAD) continues to be associated with considerable 
      mortality and morbidity. The detrimental effects of elevated heart rate (HR) on 
      cardiac morbidity and mortality are well established. Although beta-blockers 
      represent the mainstay of treatment of patients with CAD and heart failure (HF), 
      according to current guidelines, these drugs are most often undertitrated for 
      various reasons despite the lack of real contraindications. This observational, 
      cross-sectional, multicenter survey was designed to assess which clinical 
      variables influence HR and whether HR is adequately controlled; and the rate of 
      administration of beta-blockers in patients with chronic CAD attending outpatient 
      clinics. METHODS: Over 6 months 2226 (of 2362 screened) outpatients with stable 
      CAD and resting HR > 60 beats/min (bpm) were enrolled. Left ventricular systolic 
      function was not a criterion of inclusion. Each patient had a full clinical 
      examination and the past medical history, angina, or HF-related symptoms were 
      evaluated. In each patient, the demographics and cardiovascular risk factors were 
      assessed; weight, height, and body mass index (BMI) was calculated; sitting blood 
      pressure and a HR by a 12-lead electrocardiogram was obtained. RESULTS: Overall, 
      45.4% of patients with CAD were not under beta-blocker therapy. Male patients 
      featured a significantly lower HR than females, corrected from beta-blockers use. In 
      multiple regression analysis, which also included the use/nonuse of beta-blockers as 
      independent variable, not using beta-blockers, female sex (OR 2.55), New York Heart 
      Association (NYHA) classes I and II (OR 1.62 vs classes III-IV), smoking (OR 
      0.89), and increased BMI (OR 0.14) were all independent determinants of resting 
      HR, with the lack of beta-blockade therapy (OR 3.35) being the main determinant of 
      the magnitude of HR increase. Heart rate in patients under beta-blocker therapy was 
      significantly less than in untreated patients (73.6 +/- 10.0 vs 77.1 +/- 10.4, P < 
      .0001), although it often did not reach target values of <70 bpm. Among patients 
      with HF symptoms, 56.6% were under beta-blocker therapy. In patients free of 
      symptoms of HF, HR was significantly less in those receiving a beta-blocker (72.3 +/- 
      10 vs 76.7 +/- 11 bpm, P < .0001). CONCLUSION: This survey demonstrates that HR is 
      poorly controlled in a broadly representative cohort of outpatients with CAD, 
      even in those on beta-blocker therapy, mainly because of undertitration of 
      therapy-almost half of the patients with CAD and elevated resting HR are not on 
      beta-blockers. This might be related to absolute or relative controindications and 
      to haemodynamic and chronotropic intolerance to beta-blockers.
FAU - Vitale, Cristiana
AU  - Vitale C
AD  - Centre for Clinical and Basic Research, Department of Medical Sciences, IRCCS San 
      Raffaele Pisana, Roma, Italy. cristiana.vitale@sanraffaele.it
FAU - Iellamo, Ferdinando
AU  - Iellamo F
FAU - Volterrani, Maurizio
AU  - Volterrani M
FAU - Lombardi, Mariaelena
AU  - Lombardi M
FAU - Fini, Massimo
AU  - Fini M
FAU - Banach, Maciej
AU  - Banach M
FAU - Rosano, Giuseppe M C
AU  - Rosano GM
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PT  - Research Support, Non-U.S. Gov't
DEP - 20100512
PL  - United States
TA  - Angiology
JT  - Angiology
JID - 0203706
RN  - 0 (Adrenergic beta-Antagonists)
SB  - IM
MH  - Adrenergic beta-Antagonists/therapeutic use
MH  - Aged
MH  - Body Mass Index
MH  - Coronary Artery Disease/complications/drug therapy/*physiopathology
MH  - Cross-Sectional Studies
MH  - Female
MH  - Heart Failure/complications/physiopathology
MH  - *Heart Rate
MH  - Humans
MH  - Male
MH  - Sex Characteristics
MH  - Smoking
EDAT- 2010/05/14 06:00
MHDA- 2010/11/03 06:00
CRDT- 2010/05/14 06:00
PHST- 2010/05/14 06:00 [entrez]
PHST- 2010/05/14 06:00 [pubmed]
PHST- 2010/11/03 06:00 [medline]
AID - 0003319710369102 [pii]
AID - 10.1177/0003319710369102 [doi]
PST - ppublish
SO  - Angiology. 2010 Nov;61(8):763-7. doi: 10.1177/0003319710369102. Epub 2010 May 12.