title: Heart rate awareness in patients with chronic stable heart failure. A multi-center observational study.
abstract: OBJECTIVE
  We assessed adherence to European Society of Cardiology heart rate guidelines (i.e. heart rates less than 70 bpm) in patients with chronic stable heart failure. We also investigated the percent of patients on target doses of rate controlling drugs.
  
  
  METHODS
  Multicenter study involving 549 patients from 12 heart failure centers in the Republic of Ireland. Patients in sinus rhythm with stabilized heart failure treatment and without recent cardiac events were included. Resting heart rates, demographics, co-morbidities and heart failure therapies were recorded.
  
  
  RESULTS
  Heart rates ≥ 70 bpm were noted in 176 (32.1%) patients with 117 (21.3%) having rates > 75 bpm. Non-achievement of target heart rates were unrelated to age, gender or most cardiovascular risk factors. However, 42% of patients with diabetes (p<0.01), 56% of those with COPD (p<0.0001) and 46% of those with NYHA Class 3 (p<0.05) did not achieve target heart rates. Fifty eight (11%) subjects were not on beta-blockers and of these forty subjects (69%) (p<0001) did not achieve target heart rates. Of those on beta-blockers only 25% were at target dose. However, beta-blocker dosage was unrelated to achieving target heart rates. Ivabradine was used in 11% of patients with 10% at target dosage.
  
  
  CONCLUSIONS
  This study highlights that a third of "stabilized" chronic heart failure patients have not reached recommended target heart rates. Respiratory problems, diabetes and marked dyspnea were associated with poorer rate control. Guideline unawareness, inadequate beta-blocker titration and under use of ivabradine may prevent patients gaining the proven benefits of heart rate control.
authors.affiliation: Adelaide and Meath Hospital, Tallaght, Dublin 24, Ireland. Electronic address: darraghmoran@gmail.com.
authors.forename: D
authors.initials: D
authors.lastname: Moran
authors.affiliation: Wexford General Hospital, Co. Wexford, Ireland.
authors.forename: A
authors.initials: A
authors.lastname: Buckley
authors.affiliation: Galway University Hospital, Galway, Ireland.
authors.forename: K
authors.initials: K
authors.lastname: Daly
authors.affiliation: University Hospital Limerick, Limerick, Ireland.
authors.forename: B
authors.initials: B
authors.lastname: Meaney
authors.affiliation: Cork University Hospital, Cork, Ireland.
authors.forename: R
authors.initials: R
authors.lastname: Curtin
authors.affiliation: Connolly Hospital Blanchardstown, Dublin 7, Ireland.
authors.forename: J O
authors.initials: JO
authors.lastname: O'Neill
authors.affiliation: South Tipperary General Hospital, Co. Tipperary, Ireland.
authors.forename: N
authors.initials: N
authors.lastname: Colwell
authors.affiliation: Mater Misercordiae University Hospital, Dublin 7, Ireland.
authors.forename: N
authors.initials: N
authors.lastname: Mahon
authors.affiliation: Our Lady of Lourdes Hospital, Drogheda, Co. Louth, Ireland.
authors.forename: N
authors.initials: N
authors.lastname: Murphy
authors.affiliation: St. Vincent's University Hospital, Dublin 4, Ireland.
authors.forename: R
authors.initials: R
authors.lastname: O'Hanlon
authors.affiliation: St. James' University Hospital, Dublin 8, Ireland.
authors.forename: C
authors.initials: C
authors.lastname: Daly
authors.affiliation: Beaumont Hospital, Dublin 9, Ireland.
authors.forename: B
authors.initials: B
authors.lastname: Mc Adam
authors.affiliation: St. Vincent's University Hospital, Dublin 4, Ireland.
authors.forename: K
authors.initials: K
authors.lastname: Mc Donald
authors.affiliation: Adelaide and Meath Hospital, Tallaght, Dublin 24, Ireland. Electronic address: vmaher@gmail.com.
authors.forename: V
authors.initials: V
authors.lastname: Maher
mesh_terms: D000368:Aged; D001364:Awareness / Q000502:physiology*; D002908:Chronic Disease; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000503:physiopathology* / Q000523:psychology; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged
keywords: Beta blockers; Guidelines; Heart failure; Heart rate; Ivabradine