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
Background In 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 signif...
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| Veröffentlicht in: | Clinical research in cardiology 2019-07, Vol.108 (7), p.797-805 |
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| creator | Mordi, Ify R. Santema, Bernadet T. Kloosterman, Mariëlle Choy, Anna-Maria Rienstra, Michiel van Gelder, Isabelle Anker, Stefan D. Cleland, John G. Dickstein, Kenneth Filippatos, Gerasimos van der Harst, Pim Hillege, Hans L. Metra, Marco Ng, Leong L. Ouwerkerk, Wouter Ponikowski, Piotr Samani, Nilesh J. van Veldhuisen, Dirk J. Zwinderman, Aeilko H. Zannad, Faiez Voors, Adriaan A. Lang, Chim C. |
| description | Background
In 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).
Methods
We 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 21 months. Patients were evaluated at baseline and at 9 months. The combined primary outcome was all-cause mortality and heart failure hospitalisation stratified by heart rhythm and heart rate at baseline.
Results
Despite similar changes in heart rate and beta-blocker dose, a decrease in heart rate at 9 months was associated with reduced incidence of the primary outcome in both SR and AF patients [HR per 10 bpm decrease—SR: 0.83 (0.75–0.91),
p
|
| doi_str_mv | 10.1007/s00392-018-1409-x |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6584244</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2163284482</sourcerecordid><originalsourceid>FETCH-LOGICAL-c504t-939332d3146e099740bb2acbf643eefaf0e0fb7f2481cd488db36aee82304ca83</originalsourceid><addsrcrecordid>eNp1ks-O0zAQxiMEYpfCA3BBlrjAIeB_TZML0moFLFIlOMDZcpxx45LaxXa62xfleZg2pcBKnDLx_L5vPNZXFM8ZfcMoXbxNlIqGl5TVJZO0Ke8eFJesrlhJq4Y_PNe1vCiepLSmdM6okI-LC0ErrGp-Wfz8EsPKh5SdIcmtvLPOaG-ABEtMr_0KEnGe9KBjJlFnIDYMQ7h1fkXGbXYZz1zwB7yFrMt2COY7xKNoiy3wOZFbl3uSxrYMqNjoYdiTHAHNupOx1W4YI0xghG402II1mKO3jXoq0DM5PyYS-33uN2SHg_BP5-j0QKxroxuG432eFo-sHhI8O31nxbcP779e35TLzx8_XV8tSzOnMpeNaITgnWCyAto0C0nblmvT2koKAKstBWrbheWyZqaTdd21otIANRdUGl2LWfFu8t2O7QY6g-tGPahtxDXjXgXt1L8d73q1CjtVzWvJpUSD15NBf092c7VUhzMqFpVkC75jyL46DYvhxwgpq41LBnBlD2FMijMkqWzoAtGX99B1GKPHpzhQgtdS4g6zgk2UiSGlCPZ8A0bVIWFqSpjChKlDwtQdal78vfFZ8TtSCPAJSNjC_MQ_o__v-guB2-N3</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2163284482</pqid></control><display><type>article</type><title>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</title><source>MEDLINE</source><source>Springer Nature - Complete Springer Journals</source><creator>Mordi, Ify R. ; Santema, Bernadet T. ; Kloosterman, Mariëlle ; Choy, Anna-Maria ; Rienstra, Michiel ; van Gelder, Isabelle ; Anker, Stefan D. ; Cleland, John G. ; Dickstein, Kenneth ; Filippatos, Gerasimos ; van der Harst, Pim ; Hillege, Hans L. ; Metra, Marco ; Ng, Leong L. ; Ouwerkerk, Wouter ; Ponikowski, Piotr ; Samani, Nilesh J. ; van Veldhuisen, Dirk J. ; Zwinderman, Aeilko H. ; Zannad, Faiez ; Voors, Adriaan A. ; Lang, Chim C.</creator><creatorcontrib>Mordi, Ify R. ; Santema, Bernadet T. ; Kloosterman, Mariëlle ; Choy, Anna-Maria ; Rienstra, Michiel ; van Gelder, Isabelle ; Anker, Stefan D. ; Cleland, John G. ; Dickstein, Kenneth ; Filippatos, Gerasimos ; van der Harst, Pim ; Hillege, Hans L. ; Metra, Marco ; Ng, Leong L. ; Ouwerkerk, Wouter ; Ponikowski, Piotr ; Samani, Nilesh J. ; van Veldhuisen, Dirk J. ; Zwinderman, Aeilko H. ; Zannad, Faiez ; Voors, Adriaan A. ; Lang, Chim C.</creatorcontrib><description>Background
In 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).
Methods
We 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 21 months. Patients were evaluated at baseline and at 9 months. The combined primary outcome was all-cause mortality and heart failure hospitalisation stratified by heart rhythm and heart rate at baseline.
Results
Despite similar changes in heart rate and beta-blocker dose, a decrease in heart rate at 9 months was associated with reduced incidence of the primary outcome in both SR and AF patients [HR per 10 bpm decrease—SR: 0.83 (0.75–0.91),
p
< 0.001; AF: 0.89 (0.81–0.98),
p
= 0.018], whereas the relationship was less strong for achieved heart rate in AF [HR per 10 bpm higher—SR: 1.26 (1.10–1.46),
p
= 0.001; AF: 1.08 (0.94–1.23),
p
= 0.18]. Achieved heart rate at 9 months was only prognostically significant in AF patients with high baseline heart rates (
p
for interaction 0.017 vs. low).
Conclusions
Following beta-blocker uptitration, both achieved and change in heart rate were prognostically significant regardless of starting heart rate in SR, however, they were only significant in AF patients with high baseline heart rate.</description><identifier>ISSN: 1861-0684</identifier><identifier>ISSN: 1861-0692</identifier><identifier>EISSN: 1861-0692</identifier><identifier>DOI: 10.1007/s00392-018-1409-x</identifier><identifier>PMID: 30610382</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Adrenergic beta-Antagonists - administration & dosage ; Aged ; Atrial Fibrillation - complications ; Atrial Fibrillation - drug therapy ; Atrial Fibrillation - physiopathology ; Beta blockers ; Cardiac arrhythmia ; Cardiology ; Cardiology and cardiovascular system ; Congestive heart failure ; Dosage ; Dose-Response Relationship, Drug ; Ejection fraction ; Electrocardiography ; Female ; Fibrillation ; Follow-Up Studies ; Heart failure ; Heart Failure - complications ; Heart Failure - drug therapy ; Heart Failure - physiopathology ; Heart rate ; Heart Rate - drug effects ; Human health and pathology ; Humans ; Life Sciences ; Male ; Medicine ; Medicine & Public Health ; Optimization ; Original Paper ; Patients ; Prognosis ; Prospective Studies ; Rhythm ; Stroke Volume - physiology ; Treatment Outcome</subject><ispartof>Clinical research in cardiology, 2019-07, Vol.108 (7), p.797-805</ispartof><rights>The Author(s) 2019</rights><rights>Clinical Research in Cardiology is a copyright of Springer, (2019). All Rights Reserved. © 2019. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Distributed under a Creative Commons Attribution 4.0 International License</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c504t-939332d3146e099740bb2acbf643eefaf0e0fb7f2481cd488db36aee82304ca83</citedby><cites>FETCH-LOGICAL-c504t-939332d3146e099740bb2acbf643eefaf0e0fb7f2481cd488db36aee82304ca83</cites><orcidid>0000-0002-2713-686X ; 0000-0002-2686-729X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00392-018-1409-x$$EPDF$$P50$$Gspringer$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00392-018-1409-x$$EHTML$$P50$$Gspringer$$Hfree_for_read</linktohtml><link.rule.ids>230,314,776,780,881,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30610382$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://hal.univ-lorraine.fr/hal-03764172$$DView record in HAL$$Hfree_for_read</backlink></links><search><creatorcontrib>Mordi, Ify R.</creatorcontrib><creatorcontrib>Santema, Bernadet T.</creatorcontrib><creatorcontrib>Kloosterman, Mariëlle</creatorcontrib><creatorcontrib>Choy, Anna-Maria</creatorcontrib><creatorcontrib>Rienstra, Michiel</creatorcontrib><creatorcontrib>van Gelder, Isabelle</creatorcontrib><creatorcontrib>Anker, Stefan D.</creatorcontrib><creatorcontrib>Cleland, John G.</creatorcontrib><creatorcontrib>Dickstein, Kenneth</creatorcontrib><creatorcontrib>Filippatos, Gerasimos</creatorcontrib><creatorcontrib>van der Harst, Pim</creatorcontrib><creatorcontrib>Hillege, Hans L.</creatorcontrib><creatorcontrib>Metra, Marco</creatorcontrib><creatorcontrib>Ng, Leong L.</creatorcontrib><creatorcontrib>Ouwerkerk, Wouter</creatorcontrib><creatorcontrib>Ponikowski, Piotr</creatorcontrib><creatorcontrib>Samani, Nilesh J.</creatorcontrib><creatorcontrib>van Veldhuisen, Dirk J.</creatorcontrib><creatorcontrib>Zwinderman, Aeilko H.</creatorcontrib><creatorcontrib>Zannad, Faiez</creatorcontrib><creatorcontrib>Voors, Adriaan A.</creatorcontrib><creatorcontrib>Lang, Chim C.</creatorcontrib><title>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</title><title>Clinical research in cardiology</title><addtitle>Clin Res Cardiol</addtitle><addtitle>Clin Res Cardiol</addtitle><description>Background
In 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).
Methods
We 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 21 months. Patients were evaluated at baseline and at 9 months. The combined primary outcome was all-cause mortality and heart failure hospitalisation stratified by heart rhythm and heart rate at baseline.
Results
Despite similar changes in heart rate and beta-blocker dose, a decrease in heart rate at 9 months was associated with reduced incidence of the primary outcome in both SR and AF patients [HR per 10 bpm decrease—SR: 0.83 (0.75–0.91),
p
< 0.001; AF: 0.89 (0.81–0.98),
p
= 0.018], whereas the relationship was less strong for achieved heart rate in AF [HR per 10 bpm higher—SR: 1.26 (1.10–1.46),
p
= 0.001; AF: 1.08 (0.94–1.23),
p
= 0.18]. Achieved heart rate at 9 months was only prognostically significant in AF patients with high baseline heart rates (
p
for interaction 0.017 vs. low).
Conclusions
Following beta-blocker uptitration, both achieved and change in heart rate were prognostically significant regardless of starting heart rate in SR, however, they were only significant in AF patients with high baseline heart rate.</description><subject>Adrenergic beta-Antagonists - administration & dosage</subject><subject>Aged</subject><subject>Atrial Fibrillation - complications</subject><subject>Atrial Fibrillation - drug therapy</subject><subject>Atrial Fibrillation - physiopathology</subject><subject>Beta blockers</subject><subject>Cardiac arrhythmia</subject><subject>Cardiology</subject><subject>Cardiology and cardiovascular system</subject><subject>Congestive heart failure</subject><subject>Dosage</subject><subject>Dose-Response Relationship, Drug</subject><subject>Ejection fraction</subject><subject>Electrocardiography</subject><subject>Female</subject><subject>Fibrillation</subject><subject>Follow-Up Studies</subject><subject>Heart failure</subject><subject>Heart Failure - complications</subject><subject>Heart Failure - drug therapy</subject><subject>Heart Failure - physiopathology</subject><subject>Heart rate</subject><subject>Heart Rate - drug effects</subject><subject>Human health and pathology</subject><subject>Humans</subject><subject>Life Sciences</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Optimization</subject><subject>Original Paper</subject><subject>Patients</subject><subject>Prognosis</subject><subject>Prospective Studies</subject><subject>Rhythm</subject><subject>Stroke Volume - physiology</subject><subject>Treatment Outcome</subject><issn>1861-0684</issn><issn>1861-0692</issn><issn>1861-0692</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp1ks-O0zAQxiMEYpfCA3BBlrjAIeB_TZML0moFLFIlOMDZcpxx45LaxXa62xfleZg2pcBKnDLx_L5vPNZXFM8ZfcMoXbxNlIqGl5TVJZO0Ke8eFJesrlhJq4Y_PNe1vCiepLSmdM6okI-LC0ErrGp-Wfz8EsPKh5SdIcmtvLPOaG-ABEtMr_0KEnGe9KBjJlFnIDYMQ7h1fkXGbXYZz1zwB7yFrMt2COY7xKNoiy3wOZFbl3uSxrYMqNjoYdiTHAHNupOx1W4YI0xghG402II1mKO3jXoq0DM5PyYS-33uN2SHg_BP5-j0QKxroxuG432eFo-sHhI8O31nxbcP779e35TLzx8_XV8tSzOnMpeNaITgnWCyAto0C0nblmvT2koKAKstBWrbheWyZqaTdd21otIANRdUGl2LWfFu8t2O7QY6g-tGPahtxDXjXgXt1L8d73q1CjtVzWvJpUSD15NBf092c7VUhzMqFpVkC75jyL46DYvhxwgpq41LBnBlD2FMijMkqWzoAtGX99B1GKPHpzhQgtdS4g6zgk2UiSGlCPZ8A0bVIWFqSpjChKlDwtQdal78vfFZ8TtSCPAJSNjC_MQ_o__v-guB2-N3</recordid><startdate>20190701</startdate><enddate>20190701</enddate><creator>Mordi, Ify R.</creator><creator>Santema, Bernadet T.</creator><creator>Kloosterman, Mariëlle</creator><creator>Choy, Anna-Maria</creator><creator>Rienstra, Michiel</creator><creator>van Gelder, Isabelle</creator><creator>Anker, Stefan D.</creator><creator>Cleland, John G.</creator><creator>Dickstein, Kenneth</creator><creator>Filippatos, Gerasimos</creator><creator>van der Harst, Pim</creator><creator>Hillege, Hans L.</creator><creator>Metra, Marco</creator><creator>Ng, Leong L.</creator><creator>Ouwerkerk, Wouter</creator><creator>Ponikowski, Piotr</creator><creator>Samani, Nilesh J.</creator><creator>van Veldhuisen, Dirk J.</creator><creator>Zwinderman, Aeilko H.</creator><creator>Zannad, Faiez</creator><creator>Voors, Adriaan A.</creator><creator>Lang, Chim C.</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><general>Springer Verlag</general><scope>C6C</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M7Z</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>1XC</scope><scope>VOOES</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-2713-686X</orcidid><orcidid>https://orcid.org/0000-0002-2686-729X</orcidid></search><sort><creationdate>20190701</creationdate><title>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</title><author>Mordi, Ify R. ; Santema, Bernadet T. ; Kloosterman, Mariëlle ; Choy, Anna-Maria ; Rienstra, Michiel ; van Gelder, Isabelle ; Anker, Stefan D. ; Cleland, John G. ; Dickstein, Kenneth ; Filippatos, Gerasimos ; van der Harst, Pim ; Hillege, Hans L. ; Metra, Marco ; Ng, Leong L. ; Ouwerkerk, Wouter ; Ponikowski, Piotr ; Samani, Nilesh J. ; van Veldhuisen, Dirk J. ; Zwinderman, Aeilko H. ; Zannad, Faiez ; Voors, Adriaan A. ; Lang, Chim C.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c504t-939332d3146e099740bb2acbf643eefaf0e0fb7f2481cd488db36aee82304ca83</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Adrenergic beta-Antagonists - administration & dosage</topic><topic>Aged</topic><topic>Atrial Fibrillation - complications</topic><topic>Atrial Fibrillation - drug therapy</topic><topic>Atrial Fibrillation - physiopathology</topic><topic>Beta blockers</topic><topic>Cardiac arrhythmia</topic><topic>Cardiology</topic><topic>Cardiology and cardiovascular system</topic><topic>Congestive heart failure</topic><topic>Dosage</topic><topic>Dose-Response Relationship, Drug</topic><topic>Ejection fraction</topic><topic>Electrocardiography</topic><topic>Female</topic><topic>Fibrillation</topic><topic>Follow-Up Studies</topic><topic>Heart failure</topic><topic>Heart Failure - complications</topic><topic>Heart Failure - drug therapy</topic><topic>Heart Failure - physiopathology</topic><topic>Heart rate</topic><topic>Heart Rate - drug effects</topic><topic>Human health and pathology</topic><topic>Humans</topic><topic>Life Sciences</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Optimization</topic><topic>Original Paper</topic><topic>Patients</topic><topic>Prognosis</topic><topic>Prospective Studies</topic><topic>Rhythm</topic><topic>Stroke Volume - physiology</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Mordi, Ify R.</creatorcontrib><creatorcontrib>Santema, Bernadet T.</creatorcontrib><creatorcontrib>Kloosterman, Mariëlle</creatorcontrib><creatorcontrib>Choy, Anna-Maria</creatorcontrib><creatorcontrib>Rienstra, Michiel</creatorcontrib><creatorcontrib>van Gelder, Isabelle</creatorcontrib><creatorcontrib>Anker, Stefan D.</creatorcontrib><creatorcontrib>Cleland, John G.</creatorcontrib><creatorcontrib>Dickstein, Kenneth</creatorcontrib><creatorcontrib>Filippatos, Gerasimos</creatorcontrib><creatorcontrib>van der Harst, Pim</creatorcontrib><creatorcontrib>Hillege, Hans L.</creatorcontrib><creatorcontrib>Metra, Marco</creatorcontrib><creatorcontrib>Ng, Leong L.</creatorcontrib><creatorcontrib>Ouwerkerk, Wouter</creatorcontrib><creatorcontrib>Ponikowski, Piotr</creatorcontrib><creatorcontrib>Samani, Nilesh J.</creatorcontrib><creatorcontrib>van Veldhuisen, Dirk J.</creatorcontrib><creatorcontrib>Zwinderman, Aeilko H.</creatorcontrib><creatorcontrib>Zannad, Faiez</creatorcontrib><creatorcontrib>Voors, Adriaan A.</creatorcontrib><creatorcontrib>Lang, Chim C.</creatorcontrib><collection>Springer Nature OA/Free Journals</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biochemistry Abstracts 1</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>Hyper Article en Ligne (HAL)</collection><collection>Hyper Article en Ligne (HAL) (Open Access)</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Clinical research in cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mordi, Ify R.</au><au>Santema, Bernadet T.</au><au>Kloosterman, Mariëlle</au><au>Choy, Anna-Maria</au><au>Rienstra, Michiel</au><au>van Gelder, Isabelle</au><au>Anker, Stefan D.</au><au>Cleland, John G.</au><au>Dickstein, Kenneth</au><au>Filippatos, Gerasimos</au><au>van der Harst, Pim</au><au>Hillege, Hans L.</au><au>Metra, Marco</au><au>Ng, Leong L.</au><au>Ouwerkerk, Wouter</au><au>Ponikowski, Piotr</au><au>Samani, Nilesh J.</au><au>van Veldhuisen, Dirk J.</au><au>Zwinderman, Aeilko H.</au><au>Zannad, Faiez</au><au>Voors, Adriaan A.</au><au>Lang, Chim C.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>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</atitle><jtitle>Clinical research in cardiology</jtitle><stitle>Clin Res Cardiol</stitle><addtitle>Clin Res Cardiol</addtitle><date>2019-07-01</date><risdate>2019</risdate><volume>108</volume><issue>7</issue><spage>797</spage><epage>805</epage><pages>797-805</pages><issn>1861-0684</issn><issn>1861-0692</issn><eissn>1861-0692</eissn><abstract>Background
In 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).
Methods
We 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 21 months. Patients were evaluated at baseline and at 9 months. The combined primary outcome was all-cause mortality and heart failure hospitalisation stratified by heart rhythm and heart rate at baseline.
Results
Despite similar changes in heart rate and beta-blocker dose, a decrease in heart rate at 9 months was associated with reduced incidence of the primary outcome in both SR and AF patients [HR per 10 bpm decrease—SR: 0.83 (0.75–0.91),
p
< 0.001; AF: 0.89 (0.81–0.98),
p
= 0.018], whereas the relationship was less strong for achieved heart rate in AF [HR per 10 bpm higher—SR: 1.26 (1.10–1.46),
p
= 0.001; AF: 1.08 (0.94–1.23),
p
= 0.18]. Achieved heart rate at 9 months was only prognostically significant in AF patients with high baseline heart rates (
p
for interaction 0.017 vs. low).
Conclusions
Following beta-blocker uptitration, both achieved and change in heart rate were prognostically significant regardless of starting heart rate in SR, however, they were only significant in AF patients with high baseline heart rate.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>30610382</pmid><doi>10.1007/s00392-018-1409-x</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-2713-686X</orcidid><orcidid>https://orcid.org/0000-0002-2686-729X</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1861-0684 |
| ispartof | Clinical research in cardiology, 2019-07, Vol.108 (7), p.797-805 |
| issn | 1861-0684 1861-0692 1861-0692 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6584244 |
| source | MEDLINE; Springer Nature - Complete Springer Journals |
| subjects | Adrenergic beta-Antagonists - administration & dosage Aged Atrial Fibrillation - complications Atrial Fibrillation - drug therapy Atrial Fibrillation - physiopathology Beta blockers Cardiac arrhythmia Cardiology Cardiology and cardiovascular system Congestive heart failure Dosage Dose-Response Relationship, Drug Ejection fraction Electrocardiography Female Fibrillation Follow-Up Studies Heart failure Heart Failure - complications Heart Failure - drug therapy Heart Failure - physiopathology Heart rate Heart Rate - drug effects Human health and pathology Humans Life Sciences Male Medicine Medicine & Public Health Optimization Original Paper Patients Prognosis Prospective Studies Rhythm Stroke Volume - physiology Treatment Outcome |
| title | 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 |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-31T15%3A12%3A44IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Prognostic%20significance%20of%20changes%20in%20heart%20rate%20following%20uptitration%20of%20beta-blockers%20in%20patients%20with%20sub-optimally%20treated%20heart%20failure%20with%20reduced%20ejection%20fraction%20in%20sinus%20rhythm%20versus%20atrial%20fibrillation&rft.jtitle=Clinical%20research%20in%20cardiology&rft.au=Mordi,%20Ify%20R.&rft.date=2019-07-01&rft.volume=108&rft.issue=7&rft.spage=797&rft.epage=805&rft.pages=797-805&rft.issn=1861-0684&rft.eissn=1861-0692&rft_id=info:doi/10.1007/s00392-018-1409-x&rft_dat=%3Cproquest_pubme%3E2163284482%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2163284482&rft_id=info:pmid/30610382&rfr_iscdi=true |