Heart rate and use of beta-blockers in stable outpatients with coronary artery disease

Steg, P.G., Ferrari, R., Ford, I. , Greenlaw, N., Tardif, J.-C., Tendera, M., Abergel, H. and Fox, K. (2012) Heart rate and use of beta-blockers in stable outpatients with coronary artery disease. PLoS ONE, 7(5), e36284. (doi: 10.1371/journal.pone.0036284) (PMID:22570699) (PMCID:PMC3343045)

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Publisher's URL: http://dx.doi.org/10.1371/journal.pone.0036284

Abstract

<p><b>Background:</b> Heart rate (HR) is an emerging risk factor in coronary artery disease (CAD). However, there is little contemporary data regarding HR and the use of HR-lowering medications, particularly beta-blockers, among patients with stable CAD in routine clinical practice. The goal of the present analysis was to describe HR in such patients, overall and in relation to beta-blocker use, and to describe the determinants of HR.</p> <p><b>Methods and Findings:</b> CLARIFY is an international, prospective, observational, longitudinal registry of outpatients with stable CAD, defined as prior myocardial infarction or revascularization procedure, evidence of coronary stenosis of >50%, or chest pain associated with proven myocardial ischemia. A total of 33,438 patients from 45 countries in Europe, the Americas, Africa, Middle East, and Asia/Pacific were enrolled between November 2009 and July 2010. Most of the 33,177 patients included in this analysis were men (77.5%). Mean (SD) age was 64.2 (10.5) years, HR by pulse was 68.3 (10.6) bpm, and by electrocardiogram was 67.2 (11.4) bpm. Overall, 44.0% had HR≥70 bpm. Beta-blockers were used in 75.1% of patients and another 14.4% had intolerance or contraindications to beta-blocker therapy. Among 24,910 patients on beta-blockers, 41.1% had HR≥70 bpm. HR≥70 bpm was independently associated with higher prevalence and severity of angina, more frequent evidence of myocardial ischemia, and lack of use of HR-lowering agents.</p> <p><b>Conclusions:</b> Despite a high rate of use of beta-blockers, stable CAD patients often have resting HR≥70 bpm, which was associated with an overall worse health status, more frequent angina and ischemia. Further HR lowering is possible in many patients with CAD. Whether it will improve symptoms and outcomes is being tested.</p>

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Greenlaw, Miss Nicola and Ford, Professor Ian
Authors: Steg, P.G., Ferrari, R., Ford, I., Greenlaw, N., Tardif, J.-C., Tendera, M., Abergel, H., and Fox, K.
Subjects:R Medicine > R Medicine (General)
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Robertson Centre
Journal Name:PLoS ONE
Publisher:Public Library of Science
ISSN:1932-6203
ISSN (Online):1932-6203
Published Online:03 May 2012
Copyright Holders:Copyright © 2012 The Authors
First Published:First published in PLoS ONE 7(5):e36284
Publisher Policy:Reproduced in accordance with the copyright policy of the publisher

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