title: Discharge heart rate and β-blocker dose in patients hospitalized with heart failure: Findings from the OPTIMIZE-HF registry.
abstract: BACKGROUND
  Elevated heart rate of ≥70 beats/min despite β-blocker use may represent a new treatment target in patients in sinus rhythm with heart failure with reduced ejection fraction. However, little is known about the proportion of patients with elevated heart rate despite β-blocker therapy.
  
  
  METHODS
  We analyzed data from a large clinical registry to describe discharge heart rate as a function of β-blocker use and dose. We included patients with left ventricular ejection fraction <40% who were admitted with acute heart failure in 2003 and 2004; we excluded patients with a history of atrial arrhythmia or with a pacemaker or cardiac resynchronization therapy. We considered the β-blockers carvedilol, metoprolol succinate, bisoprolol, atenolol, and metoprolol tartrate and described discharge dose as a percentage of target dose (ie, <25%, 25%-49%, 50%-99%, and ≥100%).
  
  
  RESULTS
  Among 10,696 patients, median discharge heart rate was 76 beats/min (interquartile range [IQR] 66-86 beats/min). Of these, 7,826 (73%) were discharged on a β-blocker. For patients not on a β-blocker, median discharge heart rate was 80 beats/min (IQR 70-89 beats/min), compared with 78 beats/min (IQR 69-88 beats/min) on <25% of target dose, 75 beats/min (IQR 66-85 beats/min) on 25% to 49% of target dose, 74 beats/min (IQR 66-82 beats/min) on 50% to 99% of target dose, and 72 beats/min (IQR 65% to 80%) on 100% of target dose or greater (P < .001). Most patients, 7,647 (71%), had a discharge heart rate of ≥70 beats/min, including 1,460 (63%) of 2,301 patients discharged on 50% of target dose or greater.
  
  
  CONCLUSIONS
  Despite treatment with β-blockers, a substantial proportion of patients hospitalized with heart failure with reduced ejection fraction have elevated heart rate at discharge.
authors.affiliation: Duke Clinical Research Institute, Durham, NC; Department of Medicine, Duke University School of Medicine, Durham, NC. Electronic address: adam.devore@duke.edu.
authors.forename: Adam D
authors.initials: AD
authors.lastname: DeVore
authors.affiliation: Duke Clinical Research Institute, Durham, NC.
authors.forename: Xiaojuan
authors.initials: X
authors.lastname: Mi
authors.affiliation: Duke Clinical Research Institute, Durham, NC; Department of Medicine, Duke University School of Medicine, Durham, NC.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Mentz
authors.affiliation: Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles, CA.
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.affiliation: Amgen, Inc, Thousand Oaks, CA.
authors.forename: Melissa K
authors.initials: MK
authors.lastname: Van Dyke
authors.affiliation: Amgen, Inc, Thousand Oaks, CA.
authors.forename: Juan F
authors.initials: JF
authors.lastname: Maya
authors.affiliation: Duke Clinical Research Institute, Durham, NC.
authors.forename: N Chantelle
authors.initials: NC
authors.lastname: Hardy
authors.affiliation: Duke Clinical Research Institute, Durham, NC.
authors.forename: Bradley G
authors.initials: BG
authors.lastname: Hammill
authors.affiliation: Duke Clinical Research Institute, Durham, NC; Department of Medicine, Duke University School of Medicine, Durham, NC.
authors.forename: Adrian F
authors.initials: AF
authors.lastname: Hernandez
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage*; D000368:Aged; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000188:drug therapy / Q000503:physiopathology*; D006339:Heart Rate / Q000187:drug effects / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D012042:Registries; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists