title: Heart rate and use of beta-blockers in stable outpatients with coronary artery disease.
abstract: BACKGROUND
  Heart rate (HR) is an emerging risk factor in coronary artery disease (CAD). However, there is little contemporary data regarding HR and the use of HR-lowering medications, particularly beta-blockers, among patients with stable CAD in routine clinical practice. The goal of the present analysis was to describe HR in such patients, overall and in relation to beta-blocker use, and to describe the determinants of HR.
  
  
  RESULTS
  CLARIFY is an international, prospective, observational, longitudinal registry of outpatients with stable CAD, defined as prior myocardial infarction or revascularization procedure, evidence of coronary stenosis of >50%, or chest pain associated with proven myocardial ischemia. A total of 33,438 patients from 45 countries in Europe, the Americas, Africa, Middle East, and Asia/Pacific were enrolled between November 2009 and July 2010. Most of the 33,177 patients included in this analysis were men (77.5%). Mean (SD) age was 64.2 (10.5) years, HR by pulse was 68.3 (10.6) bpm, and by electrocardiogram was 67.2 (11.4) bpm. Overall, 44.0% had HR ≥ 70 bpm. Beta-blockers were used in 75.1% of patients and another 14.4% had intolerance or contraindications to beta-blocker therapy. Among 24,910 patients on beta-blockers, 41.1% had HR ≥ 70 bpm. HR ≥ 70 bpm was independently associated with higher prevalence and severity of angina, more frequent evidence of myocardial ischemia, and lack of use of HR-lowering agents.
  
  
  CONCLUSIONS
  Despite a high rate of use of beta-blockers, stable CAD patients often have resting HR ≥ 70 bpm, which was associated with an overall worse health status, more frequent angina and ischemia. Further HR lowering is possible in many patients with CAD. Whether it will improve symptoms and outcomes is being tested.
authors.affiliation: INSERM U698, Paris, France. gabriel.steg@bch.ap-hop-paris.fr
authors.forename: Ph Gabriel
authors.initials: PG
authors.lastname: Steg
authors.forename: Roberto
authors.initials: R
authors.lastname: Ferrari
authors.forename: Ian
authors.initials: I
authors.lastname: Ford
authors.forename: Nicola
authors.initials: N
authors.lastname: Greenlaw
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Tardif
authors.forename: Michal
authors.initials: M
authors.lastname: Tendera
authors.forename: Hélène
authors.initials: H
authors.lastname: Abergel
authors.forename: Kim M
authors.initials: KM
authors.lastname: Fox
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000494:pharmacology* / Q000627:therapeutic use*; D000368:Aged; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000188:drug therapy* / Q000503:physiopathology*; D003864:Depression, Chemical; D005163:Factor Analysis, Statistical; D005260:Female; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists