Int J Heart Fail.  2020 Jan;2(1):1-11. 10.36628/ijhf.2019.0009.

Optimization of Heart Failure Treatment by Heart Rate Reduction

• Böhm M
• Bewarder Y
• Kindermann I
• Slawik J
• Wintrich J
• Werner C

• KMID: 2532622
• DOI: http://doi.org/10.36628/ijhf.2019.0009

Abstract

Heart failure (HF) treatment should be optimized in addition to guideline-directed and recommended drugs to achieve an appropriate heart rate (i.e. 50−60 bpm) by ivabradine in patients with a heart rate >70 bpm in sinus rhythm and with an ejection fraction ≤35%. Heart rate reduction was to reduce cardiovascular death and HF hospitalization dependent on baseline resting heart rate. In particular in patients at a heart rate >75 bpm, a reduction in cardiovascular death, all-cause death, HF death, HF hospitalization and all-cause hospitalization has been observed. The optimal heart rate achieved appears to be between 50−60 bpm, if well tolerated as in these patients the lowest event rate is observed on treatment. Heart rate reduction is, therefore, a treatable risk factor in chronic HF. Observational studies support the concept that it is a risk indicator in other cardiovascular and non-cardiovascular conditions. Whether heart rate reduction is also modifying risk in other conditions than chronic HF should be explored in prospective clinical trials.

Keyword

Heart rate; Chronic heart failure; Ivabradine; Patient outcomes; Cardiovascular comorbidities; Heart rhythm