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High heart rate a cardiovascular risk factor in heart failure patients

By Lilian Anekwe

Researchers have shown for the first time that heart failure patients with a high resting heart rate are at higher risk of admission to hospital and death from cardiovascular causes.

Elevated heart rate is an independent risk factor for heart failure and lowering it is an important treatment target, suggests data presented at the European Society of Cardiology Congress last week.

More than 6,500 patients being treated for heart failure and a heart rate of at least 70 beats per minute (BPM) were allocated to receive ivabradine, currently licensed for angina in the UK, or placebo. Patients in the ivabradine group were started on a 5mg dose, then titrated up or down after 14 days, depending on their heart rate.

In the placebo group, patients with heart rates above 87 bpm were at more than double the risk of death from cardiovascular disease or hospitalisations for heart failure than patients with heart rates between 70 and 72 bpm. The risk of either event increased by 3% with every beat increase from baseline heart rate and by 16% for every 5 bpm increase.

Compared to placebo, ivabradine significantly reduced the number of cardiovascular-related deaths or admissions by 18%, and reduced admissions due to worsening heart failure events and deaths due to heart failure by 26% each.

Bradycardia was recorded in 10% of patients, but only 1% of the study population withdrew for this reason.

Lead researcher Professor Karl Swedberg, professor of medicine at Goteburg University, wrote in the Lancet, where the study was also published, that the trial design meant that the effect of other drugs, including beta blockers, could not be quantified.

But he maintained: ‘Our results support the importance of heart-rate reduction with ivabradine for improvement of clinical outcomes in heart failure and confirm the important role of heart rate in the pathophysiology of heart failure.’

Professor Martin Cowie, a consultant cardiologist at the Royal Brompton Hospital in London who led the UK arm of the trial, said he hoped ivabradine would quickly became part of standard heart failure management.

‘The evidence represents a significant clinical breakthrough in the management of heart failure and is incredibly important information for patients with this condition.’

‘It is vital that the results of this study are implemented and ivabradine is used as part of standard heart failure treatment as soon as possible.’

European Society of Cardiology Congress abstract no 385 and The Lancet, published online 29 August 2010

High heart rate is an independent risk factor in heart failure patients