Discharge heart rate and future events among Japanese patients with acute heart failure receiving beta-blocker therapy

Kazuki Oshima, Shun Kohsaka, Kimi Koide, Yuji Nagatomo, Toshiyuki Nagai, Yutaka Endo, Tsutomu Yoshikawa, Keiichi Fukuda

Department of Cardiology, Saitama City Hospital, Saitama, Japan.
Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan.
Division of Cardiology, Keio University School of Medicine, Tokyo, Japan.
Japan Red Cross Ashikaga Hospital, Tochigi, Japan..
National Cerebral and Cardiovascular Center, Osaka, Japan.

DOI: 10.4236/wjcd.2013.31A023                

Abstract

Background: Randomized trials have demonstrated the efficacy of beta-blockers (BBs) in heart failure (HF) patients. We sought to assess the impact of BBs on long-term outcome; in particular, we assessed the association between outcome and BB dose and discharge heart rate. Methods and Results: Prescriptions for dispensed medication and outcomes were identified from a prospective, single-institution HF registry. Long-term prognosis was compared between users and non-users of BBs. BB users were further divided into 2 groups based on dose (full and non-full dose) and discharge heart rate (<70 bpm and ≥70 bpm). The primary endpoint was defined as either death or hospitalization due to HF. Of 199 patients, 158 (79.4%) were receiving BBs at discharge. Their mean age was 66.8 ± 15.84 years. Compared with non-users of BBs, BB users were younger (65.0 ± 15.5 vs 73.8 ± 13.3 years, P = 0.001) and had a lower ejection fraction (36.0% ± 14.0% vs 48.3% ± 11.7%, p < 0.001). The use of BBs had no effect on long-term outcome (HR = 2.564, P = 0.246), whereas the event-free rate was significantly decreased with increasing heart rate (stratified by 70 bpm; log-rank P = 0.05). A discharge heart rate of >70 bpm was significantly associated with impaired long-term outcome (HR = 1.872, P = 0.04). Conclusions: Optimizing heart rate, rather than maximizing BB dose, appears to be an appropriate treatment strategy for the beta-sensitive Japanese population.

Keywords

Heart Failure; Beta-Blocker; Heart Rate; Pharmaceutical Preparations

Conflicts of Interest

The authors declare no conflicts of interest.

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