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Elevated heart rate predicts CVD deaths

By Nigel Praities

Elevated heart rate predicts cardiovascular morbidity and death in patients with coronary disease and GPs should routinely measure it, say cardiology experts

The call came after the first prospective study to look at the effect of drug treatment to lower heart rate in patients with coronary artery disease and heart failure.

The findings, presented at the European Society of Cardiology congress, lend weight to a push for routine measurement of heart rate to be incentivised through the QOF.

The BEAUTIFUL trial failed to show lowering heart rate with the drug ivabradine reduced risk of cardiovascular events and death, its primary endpoint. But it did show an effect in high-risk patients with a baseline heart rate of 70 beats per minute.

In a subanalysis of data from the trial, researchers also showed for the first time that patients with coronary disease and a heart rate over the threshold of 70 bpm were at a significantly increased risk of a serious cardiovascular outcome or death.

These patients had a 34% increased risk of cardiovascular mortality and a 53% increased risk of admission to hospital for heart failure, despite receiving optimal preventive therapy with 87% of patients receiving beta-blockers.

Professor Kim Fox, lead author and professor of clinical cardiology at the Royal Brompton Hospital, said the study showed clinicians should concentrate more on measuring heart rate in heart failure as it ‘predicts adverse outcomes'.

‘Heart rate is a highly significant predictor of outcome, predicting every outcome you can think of for cardiovascular disease,' he said.

Dr George Kassianos, a GP in Bracknell, Berkshire, and a fellow of the ESC, said the evidence was mounting that GPs should routinely measure heart rate and character in at-risk patients to spot those with a worse prognosis and those with atrial fibrillation.

‘The lesson from this study is that is that we need to check the pulse and that it should be in the QOF. It is incredible that it wasn't included this year,' he said.

Pulse palpation was recommended by the expert panel at the University of Birmingham last year as a strong contender for a future QOF indicator for atrial fibrillation.

The BEAUTIFUL trial results are also published early online in two papers in The Lancet.

TABLE: Outcomes of patients with elevated heart rates

Outcome Increased risk in patients with heart rates ?70bpm

Cardiovascular death 34%

Admission to hospital for heart failure 53%

Admission to hospital for myocardial infarction 46%

Coronary revascularisation 38%

Source: BEAUTIFUL trial data, European Society of Cardiology congress 2008

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