[Is heart rate adequately controlled in chronic systolic heart failure patients in Germany? results from a nationwide survey (INDICATE)].
BACKGROUND
Elevated resting heart rate is associated with increased morbidity and mortality in patients with chronic systolic heart failure (CHF). Lowering of heart rate improves cardiovascular outcome in these patients. Therefore, heart rate reduction is an important element of therapeutic management and consistently reflected in current European guidelines for heart failure. Methods: The INDICATE study was initiated as a multicenter nationwide cross-sectional survey aiming to analyze the current quality of care in outpatients with CHF (documented left ventricular systolic dysfunction) in Germany. 20 consecutive patients were to be included in the survey from February until June 2012 by 793 cardiologic private practices. Detailed documentation of each patient was performed using a standardized questionnaire.


RESULTS
CHF was known for more than 6 months in 88 % of the 15 148 included patients. Mean heart rate in the study population was 73 ± 13 min⁻¹. In 42 % of patients the heart rate was ≥ 75 min⁻¹. 86 % were treated with betablockers. However, higher doses of betablockers were not associated with lower resting heart rate. 27 % of patients remained on heart rates ≥ 75 min⁻¹ although receiving at least 50 % of betablocker target dose.


CONCLUSIONS
INDICATE reveals a considerable proportion of outpatients with CHF showing an elevated heart rate despite beta blockade - irrespective of applied dose. These results emphasize the importance of optimizing the pharmacological management of resting heart rate according to guidelines in these patients.
Internistische Gemeinschaftspraxis Steiner Thor, Straubing.
C
C
Zugck
Servier Deutschland GmbH, München.
P
P
Martinka
Servier Deutschland GmbH, München.
G
G
Stöckl
Medizinische Klinik für Kardiologie und Pulmologie, Campus Benjamin Franklin, Charité Universitätsmedizin, Berlin.
C
C
Tschöpe
Deutsches Zentrum für Herzinsuffizienz, Universität Würzburg.
S
S
Störk
D000293:Adolescent; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D004232:Diuretics / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005260:Female; D019983:Guideline Adherence; D054143:Heart Failure, Systolic / Q000175:diagnosis* / Q000188:drug therapy* / Q000503:physiopathology; D006339:Heart Rate / Q000187:drug effects* / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011785:Quality Assurance, Health Care; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis* / Q000188:drug therapy* / Q000503:physiopathology; D055815:Young Adult
D000319:Adrenergic beta-Antagonists; D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D004232:Diuretics