Heart Rate Control in Heart Failure

Heart Failure/treatment; Heart Rate; Patient Care Team; Medication Adherence

Heart failure (HF) is an important public health issue due to its high prevalence and the severity of clinical manifestations.¹ , ² The increment in population longevity has increased the number of hospitalizations and deaths due to HF. Recent data by DATASUS (2020) show the occurrence of 26,482 deaths from HF.³

This syndrome has a multifactorial characteristic and its treatment requires a multidisciplinary team to meet the recommendations proposed in the guidelines for the treatment of HF. Follow-up and monitoring of patients are essential for improving the clinical outcomes.⁴ - ⁶

Heart rate (HR) is considered a therapeutic target in the treatment of HF, since elevated HR is a marker of events in HF.⁴ Several studies have shown the importance of HR control to improve outcomes such as risk of death and hospital admission by HF.⁷ , ⁸

Therefore, observational studies are essential to investigate the impact of the treatment of patients with HF. In this sense, a study carried out by Cardoso et al.⁹ aimed to assess whether patients monitored in outpatient settings have their HR controlled and receive drug prescriptions according to the guidelines for the treatment of HF.⁹

A recent global study showed that despite satisfactory adherence to the recommendations of guidelines for the treatment of HF, an under-dosage of the recommended drugs is observed. Actions are needed to improve this situation, since high doses of recommended therapies are associated with reduced mortality in observational studies of patients with HF.¹⁰

In their study, Cardoso et al.⁹ mentioned that beta-blockers do not have the same effect reducing HR for all patients. Thus, the authors raised an important question of what would be more important to determine a good outcome for patients with HF, the target dose of the beta-blocker or the reduction in HR?

The study evaluated 171 patients in outpatient settings and showed very relevant data on the effectiveness of the treatment of HF on HR control. Although beta-blockers were prescribed in high doses for 98.8% of patients, a large portion (40.9%) had HR greater than 70 beats per minute. The authors also observed that other classes of drugs recommended for the treatment of HF, such as angiotensin-converting enzyme inhibitors, angiotensin receptor blockers and diuretics, were properly prescribed.⁹

Thus, considering the impact of HR on the prognosis of patients with HF, the study conducted by Cardoso et al.⁹ suggests that other actions in addition to the prescription of the recommended drug therapy need to be adopted to ensure the control of HR in patients with HF.

Referências

• ¹
  Mann DL. Pathophysiology of heart failure. In: Bonow RO, Mann DL, Zipes DP, Libby P, Braunwald E, eds. Heart Disease. A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia: Saunders Elsevier; 2012. p. 487-504
• ²
  Sociedade Brasileira de Cardiologia. Atualização da Diretriz Brasileira de Insuficiência Cardíaca Crônica – 2012. Arq Bras Cardiol. 2012;98(supl 1):1-33.
• ³
  Brasil. Ministério da Saúde. Departamento de Informática do Sistema Único de Saúde (DATASUS).. [Citado 28 maio 2020) Diponível em: <http://tabnet.datasus.gov.br/cgi/tabcgi.exe?sim/cnv/obt10uf.def>
  » http://tabnet.datasus.gov.br/cgi/tabcgi.exe?sim/cnv/obt10uf.def>
• ⁴
  Rohde LE, Montera MW, Bocchi E, Claudsell N, Albuquerque DC, Rassi S, et al. Diretriz Brasileira de Insuficiência Cardíaca Crônica e Aguda. Arq Bras Cardiol . 2018;111(3):436-539.
• ⁵
  Yancy CW, Jessup M, Bozkurt B, Butler J, Casey Jr DE, Colvin MM. 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. Circulation . 2017;136(6):e137-e161.
• ⁶
  Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J . 2016;37(27):2129-200.
• ⁷
  Swedberg K, Komajda M, Böhm M, Borer JS, Ford I, Dubost-Brama A, et al. et al. Ivabradine and outcomes in chronic heart failure (SHIFT): a randomised placebo-controlled study. Lancet . 2010;376(9744):875-85
• ⁸
  Fox K, Ford I, Steg PG, Tendera M, Ferrari R, Beautiful Investigators,. et al. Heart rate as a prognostic risk factor in patients with coronary artery disease and left-ventricular systolic dysfunction (BEAUTIFUL): a subgroup analysis of a randomised controlled trial. Lancet . 2008;372(9641):817-21.
• ⁹
  Cardoso J, Espíndola MD, Cunha M, Netto E, Cardoso C, Novaes M, et al. Is Current Drug Therapy for Heart Failure Sufficient to Control Heart Rate of Patients? Arq Bras Cardiol. 2020; 115(6):1063-1069.
• ¹⁰
  Komajda M, Anker SD, Cowie MR, Fillipatos GS, Mangelle B, Ponikowski P, et al. Physicians’ adherence to guideline-recommended medications in heart failure with reduced ejection fraction: data from the QUALIFY global survey. Eur J Heart Fail . 2016;16(5):514-22.

• Short Editorial related to the article: Is current drug therapy for heart failure sufficient to control heart rate of patients?

Publication Dates

• Publication in this collection
  18 Jan 2021
• Date of issue
  Dec 2020