Observational studyClinical research in cardiology : official journal of the German Cardiac Society2019
Prognostic significance of changes in heart rate following uptitration of beta-blockers in patients with sub-optimally treated heart failure with reduced ejection fraction in sinus rhythm versus atrial fibrillation.
Observational study in Clinical research in cardiology : official journal of the German Cardiac Society, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
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Who cites it
8 citing papers in PubMed, 11 citations in OpenAlex.
- Beta blockers linked to reduced 1-Year mortality in critically ill congestive heart failure patients with differential benefits across subgroups.Scientific reports · 2025Article
- Posttreatment pulse rate reduction and not baseline pulse rate as an indicator of blood pressure response to nebivolol: a subanalysis from the real-world BENEFIT-KOREA study.Clinical hypertension · 2025Article
- Five-year results of heart rate control with ivabradine or metoprolol succinate in patients after heart transplantation.Clinical research in cardiology : official journal of the German Cardiac Society · 2022Article
- Effects of Metoprolol Succinate Combined with Entresto on Cardiac Function Indexes and Coagulation Function in Patients with Congestive Heart Failure.Computational and mathematical methods in medicine · 2022Article
- Review
- Association of Heart Rate Trajectory Patterns with the Risk of Adverse Outcomes for Acute Heart Failure in a Heart Failure Cohort in Taiwan.Acta Cardiologica Sinica · 2020Article
- The influence of atrial fibrillation on the levels of NT-proBNP versus GDF-15 in patients with heart failure.Clinical research in cardiology : official journal of the German Cardiac Society · 2020Observational
- Does rhythm matter in acute heart failure? An insight from the British Society for Heart Failure National Audit.Clinical research in cardiology : official journal of the German Cardiac Society · 2019Article
Corrections and comments
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Authors and funding
22 authors at 12 institutions in 9 countries.
Funding
Abstract
backgroundIn patients with heart failure with reduced ejection fraction (HFrEF) on sub-optimal doses of beta-blockers, it is conceivable that changes in heart rate following treatment intensification might be important regardless of underlying heart rhythm. We aimed to compare the prognostic significance of both achieved heart rate and change in heart rate following beta-blocker uptitration in patients with HFrEF either in sinus rhythm (SR) or atrial fibrillation (AF).
methodsWe performed a post hoc analysis of the BIOSTAT-CHF study. We evaluated 1548 patients with HFrEF (mean age 67 years, 35% AF). Median follow-up was 21 months. Patients were evaluated at baseline and at 9 months. The combined primary outcome was all-cause mortality and heart failure hospitalisation stratified by heart rhythm and heart rate at baseline.
resultsDespite similar changes in heart rate and beta-blocker dose, a decrease in heart rate at 9 months was associated with reduced incidence of the primary outcome in both SR and AF patients [HR per 10 bpm decrease-SR: 0.83 (0.75-0.91), p < 0.001; AF: 0.89 (0.81-0.98), p = 0.018], whereas the relationship was less strong for achieved heart rate in AF [HR per 10 bpm higher-SR: 1.26 (1.10-1.46), p = 0.001; AF: 1.08 (0.94-1.23), p = 0.18]. Achieved heart rate at 9 months was only prognostically significant in AF patients with high baseline heart rates (p for interaction 0.017 vs. low).
conclusionsFollowing beta-blocker uptitration, both achieved and change in heart rate were prognostically significant regardless of starting heart rate in SR, however, they were only significant in AF patients with high baseline heart rate.
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