PMID- 32757485
OWN - NLM
STAT- MEDLINE
DCOM- 20210621
LR  - 20210621
IS  - 2055-5822 (Electronic)
IS  - 2055-5822 (Linking)
VI  - 7
IP  - 5
DP  - 2020 Oct
TI  - Resting heart rate in ambulatory heart failure with reduced ejection fraction 
      treated with beta-blockers.
PG  - 3049-3058
LID - 10.1002/ehf2.12931 [doi]
AB  - AIMS: Current guidelines recommend beta-blocker therapy in chronic heart failure 
      with reduced ejection fraction (HFrEF) titrated according to tolerated target 
      dose. The efficiency of this strategy to obtain adequate heart rate (HR) control 
      remains unclear in clinical practice. The aim of this study was to determine, in 
      a real-world setting, the proportion of HFrEF patients who fail to achieve 
      beta-blocker target doses, whether target doses of beta-blockers have a 
      relationship with the adequacy in reducing resting HR over time. METHODS AND 
      RESULTS: Beta-blocker dose and resting HR of consecutive ambulatory patients with 
      a diagnosis of HFrEF (ejection fraction </= 35%) in sinus rhythm were reviewed at 
      the first outpatient contact in the Cleveland Clinic Health System from the year 
      2000 to 2015. Patients who did not receive beta-blocker therapy, have congenital 
      heart disease and hypertrophic cardiomyopathy, were not in sinus rhythm, or have 
      a history of heart transplant were excluded. Patients were followed up until 
      their last known visit at the Cleveland Clinic. Median resting HR was 71 b.p.m. 
      [inter-quartile range (IQR) 60-84 b.p.m.] in 8041 patients (median age 65; 68% 
      male) with 67% on carvedilol, 32% on metoprolol succinate, and 1% on bisoprolol. 
      In 3674 subjects (56%), resting HR was >/=70 b.p.m. At final follow-up after a 
      median of 21 months (IQR 0.1-7.2 years), resting HR was 72 b.p.m. (IQR 60-84 
      b.p.m.) in the subset of patients with persistently low ejection fraction </= 35%. 
      HR >/= 70 b.p.m. was observed in 55% of this group. Beta-blocker target dose was 
      achieved in 19%, 5%, and 15% of those receiving carvedilol, metoprolol succinate, 
      and bisoprolol, respectively. In the subset of patients who experienced 
      beta-blocker up-titration, reduced mortality or hospitalization due to heart 
      failure was observed in patients who experienced the lowest HR after titration. 
      CONCLUSIONS: In our single-centre experience, the majority of patients with 
      chronic HFrEF treated with beta-blocker therapy did not achieve target doses over 
      time, and a substantial proportion had inadequate control of resting HR. There 
      was no relationship between achieved beta-blocker target dose and resting HR 
      control.
CI  - (c) 2020 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on 
      behalf of the European Society of Cardiology.
FAU - Varian, Kenneth D
AU  - Varian KD
AD  - Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland, 
      OH, USA.
FAU - Ji, Xinge
AU  - Ji X
AD  - Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland 
      Clinic, Cleveland, OH, USA.
FAU - Grodin, Justin L
AU  - Grodin JL
AD  - Department of Medicine, University of Texas Southwestern Medical School, Dallas, 
      TX, USA.
FAU - Verbrugge, Frederik H
AU  - Verbrugge FH
AD  - Center for Cardiovascular Diseases, Universitair Ziekenhuis Brussel, Brussels, 
      Belgium.
FAU - Milinovich, Alex
AU  - Milinovich A
AD  - Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland 
      Clinic, Cleveland, OH, USA.
FAU - Kattan, Michael W
AU  - Kattan MW
AD  - Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland 
      Clinic, Cleveland, OH, USA.
FAU - Tang, W H Wilson
AU  - Tang WHW
AD  - Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland, 
      OH, USA.
LA  - eng
GR  - Amgen/International
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20200805
PL  - England
TA  - ESC Heart Fail
JT  - ESC heart failure
JID - 101669191
RN  - 0 (Adrenergic beta-Antagonists)
SB  - IM
MH  - Adrenergic beta-Antagonists
MH  - Aged
MH  - Female
MH  - *Heart Failure/drug therapy
MH  - Heart Rate
MH  - Humans
MH  - Male
MH  - Retrospective Studies
MH  - Stroke Volume
PMC - PMC7524238
OTO - NOTNLM
OT  - Beta-blocker
OT  - Heart failure
OT  - Heart rate
COIS- Dr Grodin has served as consultant for Pfizer Inc and Eidos Therapeutics. Dr Tang 
      has served as consultant for Sequana Medical AG and received honorarium from 
      Springer Nature and American Board of Internal Medicine. All other authors have 
      no relationships to disclose.
EDAT- 2020/08/07 06:00
MHDA- 2021/06/22 06:00
PMCR- 2020/08/05
CRDT- 2020/08/07 06:00
PHST- 2020/03/01 00:00 [received]
PHST- 2020/07/12 00:00 [revised]
PHST- 2020/07/20 00:00 [accepted]
PHST- 2020/08/07 06:00 [pubmed]
PHST- 2021/06/22 06:00 [medline]
PHST- 2020/08/07 06:00 [entrez]
PHST- 2020/08/05 00:00 [pmc-release]
AID - EHF212931 [pii]
AID - 10.1002/ehf2.12931 [doi]
PST - ppublish
SO  - ESC Heart Fail. 2020 Oct;7(5):3049-3058. doi: 10.1002/ehf2.12931. Epub 2020 Aug 
      5.