title: Prescribing patterns to optimize heart rate: analysis of 1,000 consecutive outpatient appointments to a single heart failure clinic over a 6-month period.
abstract: OBJECTIVE
  This study sought to characterize patients attending a community heart failure (HF) clinic and identified those who were eligible for optimization of beta-blockers (BB) or ivabradine.
  
  
  BACKGROUND
  Among patients with HF due to left ventricular systolic dysfunction in sinus rhythm, those with higher resting heart rate have a worse prognosis. Reducing sinus rate to 50 to 60 beats/min might improve outcomes.
  
  
  METHODS
  A total of 1,000 consecutively scheduled HF clinic follow-up appointments over a 6-month period were reviewed. Demographic, clinical, and echocardiographic data were collected for patients who attended (824 unique patients; 555 men). Mean age was 74 ± 11 years, median N-terminal pro-B-type natriuretic peptide levels were 1,002 ng/l (interquartile range: 367 to 2,151 ng/l), and the mean left ventricular ejection fraction (LVEF) was 44 ± 11%. A total of 202 (25%), 252 (31%), and 370 (45%) patients had LVEFs of ≤35%, 36% to 49%, and ≥50%, respectively. Of patients with LVEF ≤35%, 142 (70%) were in sinus rhythm.
  
  
  RESULTS
  At 70 clinic visits, 58 patients with LVEFs of ≤35% were in sinus rhythm and had heart rates ≥70 beats/min. Of these, 13 patients had their BB dose increased, 20 were potentially eligible for, but did not have, BB uptitration, 15 were already taking target doses of BBs, and 10 patients were reported to be intolerant of higher doses. Thus, 25 patients were potentially eligible for ivabradine according to European Society of Cardiology guidelines; this number dropped to 14 when the United Kingdom National Institute for Health and Care Excellence guidelines were applied.
  
  
  CONCLUSIONS
  Among patients with LVEFs of ≤35%, most are treated with BBs and have a heart rate at rest of <70 beats/min; 12% of these patients might be eligible for ivabradine.
authors: Department of Cardiology, Hull York Medical School, Castle Hill Hospital, Kingston-upon-Hull, United Kingdom. Electronic address: r.dierckx@hull.ac.uk.
authors: Riet
authors: R
authors: Dierckx
authors: Department of Cardiology, Hull York Medical School, Castle Hill Hospital, Kingston-upon-Hull, United Kingdom; National Institute of Health Research Bio-medical Research Unit, National Heart & Lung Institute, Royal Brompton & Harefield Hospitals, Imperial College, London, United Kingdom.
authors: John G F
authors: JG
authors: Cleland
authors: Department of Cardiology, Hull York Medical School, Castle Hill Hospital, Kingston-upon-Hull, United Kingdom.
authors: Sunaina
authors: S
authors: Parsons
authors: Department of Cardiology, Hull York Medical School, Castle Hill Hospital, Kingston-upon-Hull, United Kingdom.
authors: Paola
authors: P
authors: Putzu
authors: Department of Cardiology, Hull York Medical School, Castle Hill Hospital, Kingston-upon-Hull, United Kingdom.
authors: Pierpaolo
authors: P
authors: Pellicori
authors: Department of Cardiology, Hull York Medical School, Castle Hill Hospital, Kingston-upon-Hull, United Kingdom.
authors: Benjamin
authors: B
authors: Dicken
authors: Department of Cardiology, Hull York Medical School, Castle Hill Hospital, Kingston-upon-Hull, United Kingdom.
authors: Vennela
authors: V
authors: Boyalla
authors: Department of Cardiology, Hull York Medical School, Castle Hill Hospital, Kingston-upon-Hull, United Kingdom.
authors: Andrew L
authors: AL
authors: Clark
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D001071:Appointments and Schedules; D001552:Benzazepines / Q000627:therapeutic use*; D002317:Cardiovascular Agents / Q000627:therapeutic use; D054815:Cyclic Nucleotide-Gated Cation Channels / Q000037:antagonists & inhibitors; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000188:drug therapy* / Q000503:physiopathology; D006339:Heart Rate / Q000187:drug effects* / Q000502:physiology; D006801:Humans; D000077550:Ivabradine; D008297:Male; D010045:Outpatients; D012189:Retrospective Studies; D013997:Time Factors; D016277:Ventricular Function, Left
chemical_list: D000319:Adrenergic beta-Antagonists; D001552:Benzazepines; D002317:Cardiovascular Agents; D054815:Cyclic Nucleotide-Gated Cation Channels; D000077550:Ivabradine
keywords: beta-blocker; heart failure; heart rate; ivabradine