| Heart rate achieved or beta-blocker dose in patients with chronic heart failure: which is the better target? | |
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MedLine Citation:
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PMID: 22622001 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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AIMS: To investigate whether the mortality of patients with chronic heart failure (CHF) due to left ventricular systolic dysfunction (LVSD) is more strongly related to beta-blocker dose or to heart rate. It is known that beta-blockers reduce mortality in patients with CHF and LVSD, but the primary mechanism of action is uncertain. METHODS AND RESULTS: Patients with an ejection fraction ≤40%, who were in sinus rhythm both at an initial (visit 1) and at a 4-month clinic review (visit 2), were followed for a maximum of 36 months. The relationships between heart rate, beta-blocker dose, and survival in a multivariable model were examined. Of 654 eligible patients, 381 (58%) were started on beta-blockers prior to the initial visit, increasing to 537 (82%) by visit 2. During follow-up, 142 (22%) patients died. Neither resting heart rate nor beta-blocker dose at visit 1 predicted mortality (P = 0.09 and P = 0.99), but resting heart rate at visit 2 did (P = 0.02). Beta-blocker use at visit 2 was associated with better outcome (P = 0.03) but with little variation in outcome according to dose. Patients with a heart rate of 58-64 b.p.m. at visit 2 had the best prognosis. CONCLUSIONS: The use of beta-blockers and resting heart rate at visit 2 both independently indicated prognosis, but beta-blocker dose did not. Beta-blockers may reduce mortality by several mechanisms; one that may be specific to blockade of adrenergic receptors and another related to heart rate reduction. Achieving a target heart rate range may be an appropriate therapeutic goal for patients with CHF. |
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Authors:
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Damien Cullington; Kevin M Goode; Andrew L Clark; John G F Cleland |
Publication Detail:
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Type: JOURNAL ARTICLE Date: 2012-5-22 |
Journal Detail:
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Title: European journal of heart failure Volume: - ISSN: 1879-0844 ISO Abbreviation: - Publication Date: 2012 May |
Date Detail:
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Created Date: 2012-5-24 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 100887595 Medline TA: Eur J Heart Fail Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Affiliation:
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Department of Cardiology, Post graduate Medical Institute (Hull York Medical School), University of Hull, UK. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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