Prognostic significance of changes in heart rate following uptitration of beta-blockers in patients with sub-optimally treated heart failure with reduced ejection fraction in sinus rhythm versus atrial fibrillation

Mordi, I. R., Santema, B. T., Kloosterman, M., Choy, A-M., Rienstra, M., van Gelder, I., Anker, S. D., Cleland, J. G., Dickstein, K., Filippatos, G., van der Harst, P., Hillege, H. L., Metra, M., Ng, L. L., Ouwerkerk, W., Ponikowski, P., Samani, N. J., van Veldhuisen, D. J., Zwinderman, A. H., Zannad, F., Voors, A. A. & Lang, C. C., Jul-2019, In : Clinical Research in Cardiology. 108, 7, p. 797-805 9 p.

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BackgroundIn patients with heart failure with reduced ejection fraction (HFrEF) on sub-optimal doses of beta-blockers, it is conceivable that changes in heart rate following treatment intensification might be important regardless of underlying heart rhythm. We aimed to compare the prognostic significance of both achieved heart rate and change in heart rate following beta-blocker uptitration in patients with HFrEF either in sinus rhythm (SR) or atrial fibrillation (AF).MethodsWe performed a post hoc analysis of the BIOSTAT-CHF study. We evaluated 1548 patients with HFrEF (mean age 67 years, 35% AF). Median follow-up was 21months. Patients were evaluated at baseline and at 9months. The combined primary outcome was all-cause mortality and heart failure hospitalisation stratified by heart rhythm and heart rate at baseline.ResultsDespite similar changes in heart rate and beta-blocker dose, a decrease in heart rate at 9months was associated with reduced incidence of the primary outcome in both SR and AF patients [HR per 10bpm decreaseSR: 0.83 (0.75-0.91), p

Original languageEnglish
Pages (from-to)797-805
Number of pages9
JournalClinical Research in Cardiology
Issue number7
Publication statusPublished - Jul-2019


  • Heart failure, Heart rate, Atrial fibrillation, Beta-blockers, RATE REDUCTION, OUTCOMES, CARVEDILOL, DEATH

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