title: Inadequate heart rate control despite widespread use of beta-blockers in outpatients with stable CAD: findings from the international prospective CLARIFY registry.
abstract: BACKGROUND
  To use CLARIFY, a prospective registry of patients with stable CAD (45 countries), to explore heart rate (HR) control and beta-blocker use.
  
  
  METHODS
  We analyzed the CLARIFY population according to beta-blocker use via descriptive statistics with Pearson's χ(2) test for comparisons, as well as a multivariable stepwise model.
  
  
  RESULTS
  Data on beta-blocker use was available for 32,914 patients, in whom HR was 68 ± 11 bpm; patients with angina, previous myocardial infarction, and heart failure had HRs of 69 ± 12, 68 ± 11, and 70 ± 12 bpm, respectively. 75% of these patients were receiving beta-blockers. Bisoprolol (34%), metoprolol tartrate (16%) or succinate (13%), atenolol (15%), and carvedilol (12%) were mostly used; mean dosages were 49%, 76%, 35%, 53%, and 45% of maximum doses, respectively. Patients aged <65 years were more likely to receive beta-blockers than patients ≥ 75 years (P<0.0001). Gender had no effect. Subjects with HR ≤ 60 bpm were more likely to be on beta-blockers than patients with HR ≥ 70 bpm (P<0.0001). Patients with angina, previous myocardial infarction, heart failure, and hypertension were more frequently receiving beta-blockers (all P<0.0001), and those with PAD and asthma/COPD less frequently (both P<0.0001). Beta-blocker use varied according to geographical region (from 87% to 67%).
  
  
  CONCLUSIONS
  Three-quarters of patients with stable CAD receive beta-blockers. Even so, HR is insufficiently controlled in many patients, despite recent guidelines for the management of CAD. There is still much room for improvement in HR control in the management of stable CAD.
authors.affiliation: Medical University of Silesia, Katowice, Poland.
authors.forename: Michal
authors.initials: M
authors.lastname: Tendera
authors.affiliation: NHLI Imperial College, ICMS, Royal Brompton Hospital, London, UK. Electronic address: k.fox@rbht.nhs.uk.
authors.forename: Kim
authors.initials: K
authors.lastname: Fox
authors.affiliation: Department of Cardiology and LTTA Centre, University Hospital of Ferrara and Maria Cecilia Hospital, GVM Care & Research, E.S.: Health Science Foundation, Cotignola, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Ferrari
authors.affiliation: University of Glasgow, Glasgow, UK.
authors.forename: Ian
authors.initials: I
authors.lastname: Ford
authors.affiliation: University of Glasgow, Glasgow, UK.
authors.forename: Nicola
authors.initials: N
authors.lastname: Greenlaw
authors.affiliation: INSERM U-1148, Paris, France; Université Paris Diderot, Paris, France; AP-HP, Hôpital Bichat, Paris, France.
authors.forename: Hélène
authors.initials: H
authors.lastname: Abergel
authors.affiliation: C.C. Iliescu Emergency Cardiovascular Diseases Institute, Bucharest, Romania.
authors.forename: Cezar
authors.initials: C
authors.lastname: Macarie
authors.affiliation: Montreal Heart Institute, Université de Montreal, Montreal, Canada.
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Tardif
authors.affiliation: University Hospital of Heraklion, Heraklion, Greece.
authors.forename: Panos
authors.initials: P
authors.lastname: Vardas
authors.affiliation: Instituto Cardiovascular, Hospital Universitario San Carlos, Madrid, Spain.
authors.forename: José
authors.initials: J
authors.lastname: Zamorano
authors.affiliation: NHLI Imperial College, ICMS, Royal Brompton Hospital, London, UK; INSERM U-1148, Paris, France; Université Paris Diderot, Paris, France; AP-HP, Hôpital Bichat, Paris, France.
authors.forename: P
authors.initials: P
authors.lastname: Gabriel Steg
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000494:pharmacology* / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000379:methods / Q000639:trends*; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D038622:Internationality; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries
chemical_list: D000319:Adrenergic beta-Antagonists
keywords: Beta-blocker; CLARIFY; Heart rate; Stable CAD