title: Inadequate heart rate control is associated with worse quality of life in patients with coronary artery disease and chronic obstructive pulmonary disease. The RYTHMOS study.
abstract: BACKGROUND
  Significant evidence shows that elevated heart rate (HR) is an independent risk factor in patients with coronary artery disease (CAD) and influences their prognosis. In addition, patients with chronic obstructive pulmonary disease (COPD) have more frequent episodes of angina and their compliance with heart rate agents, such as beta blockers, is poor. The purpose of the multicenter observational RYTHMOS study was to evaluate the role of heart rate management in the prognosis and quality of life in patients with CAD and COPD.
  
  
  METHODS
  Baseline data from 280 patients, enrolled in 22 hospitals representing all types of hospital and all geographical areas of the country, were analyzed. All patients had either a prior myocardial infarction or angiographically documented CAD, and COPD verified either after spirometry or from a clinical evaluation by pulmonologists.
  
  
  RESULTS
  The mean age of the enrolled patients was 71.8 ± 9.3 years, 76% were males, mean body mass index was 28.6 ± 7.9 kg/m2, 76.3% had hypertension, 31% had diabetes mellitus, and 53.5% of them suffered from heart failure. About 31% of the patients had an angina episode the week before the enrollment and the Canadian Cardiovascular Society (CSS) classification was class I, II, III and IV in 55%, 30%, 14% and 1%, respectively. The mean resting HR was 72.5 bpm; 51% of the patients had resting HR>70 bpm and 22% of them had HR80 bpm. Only 52.8% of the study patients were receiving beta-blockade (BB) therapy; they were more likely to have resting HR70 bpm (57.4% vs. 42.7%, p<0.001). 16.4% of the patients were receiving ivabradine and they had a higher initial HR compared to the others (78.5 vs. 71.3, p<0.001). Multivariate analysis showed that diabetes mellitus was independently associated with HR>70 bpm. Patients with resting HR>70 bpm had significantly more frequent angina episodes (p<0.001), were less satisfied with treatment (p<0.001), and had a lower quality of life (p<0.001).
  
  
  CONCLUSIONS
  The baseline data of this study showed that patients with CAD and COPD present inadequate HR control and frequent angina episodes. Apart from the special characteristics of these patients related to COPD management, underuse of BB therapy largely contributes to the inadequate control of HR. Patients with HR>70 bpm had significantly worse quality of life.
authors.affiliation: Henry Dunant Hospital, Athens, Greece. andrikop@hotmail.com
authors.forename: George
authors.initials: G
authors.lastname: Andrikopoulos
authors.forename: Socrates
authors.initials: S
authors.lastname: Pastromas
authors.forename: Athanasios
authors.initials: A
authors.lastname: Kartalis
authors.forename: Konstantina
authors.initials: K
authors.lastname: Toli
authors.forename: Ioannis
authors.initials: I
authors.lastname: Mantas
authors.forename: Stylianos
authors.initials: S
authors.lastname: Tzeis
authors.forename: Christos
authors.initials: C
authors.lastname: Kyrpizidis
authors.forename: Christoforos
authors.initials: C
authors.lastname: Olympios
authors.forename: Athanasios J
authors.initials: AJ
authors.lastname: Manolis
authors.forename: Stefanos
authors.initials: S
authors.lastname: Foussas
authors.forename: Athanasios
authors.initials: A
authors.lastname: Kranidis
authors.forename: Athanasios
authors.initials: A
authors.lastname: Pras
authors.forename: Athanasios
authors.initials: A
authors.lastname: Pipilis
authors.forename: Dimitris
authors.initials: D
authors.lastname: Chryssos
authors.forename: Alexandros
authors.initials: A
authors.lastname: Gotsis
authors.forename: Athanasios
authors.initials: A
authors.lastname: Trikas
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Richter
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Alexopoulos
authors.forename: Fragiskos
authors.initials: F
authors.lastname: Parthenakis
authors.forename: George
authors.initials: G
authors.lastname: Theodorakis
authors.forename: Stavros
authors.initials: S
authors.lastname: Konstantinides
authors.forename: Panos
authors.initials: P
authors.lastname: Vardas
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D003324:Coronary Artery Disease / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate / Q000187:drug effects* / Q000502:physiology; D006801:Humans; D008297:Male; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D011788:Quality of Life; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists