Heart rate as a prognostic risk factor in patients with coronary artery disease and left-ventricular systolic dysfunction (BEAUTIFUL): a subgroup analysis of a randomised controlled trial

@article{Fox2008HeartRA,
  title={Heart rate as a prognostic risk factor in patients with coronary artery disease and left-ventricular systolic dysfunction (BEAUTIFUL): a subgroup analysis of a randomised controlled trial},
  author={Kim Fox and Ian Ford and Philippe Gabriel Steg and Michal Tendera and Michele Robertson and Roberto Ferrari},
  journal={The Lancet},
  year={2008},
  volume={372},
  pages={817-821}
}

Current status: heart rate as a treatable risk factor

TLDR
The BEAUTIFUL trial and SHIFT provide evidence for the benefits of heart rate reduction using the new heart rate-lowering agent ivabradine, even in patients on beta-blockers.

Heart rate is associated with increased risk of major cardiovascular events, cardiovascular and all-cause death in patients with stable chronic cardiovascular disease: an analysis of ONTARGET/TRANSCEND

TLDR
Resting and, in particular, in-trial average heart rate are independently associated with significant increases in CV events and all-cause death.

Role of Heart Rate in Cardiovascular Diseases

  • J. CortadaA. Varela
  • Medicine
    American journal of cardiovascular drugs : drugs, devices, and other interventions
  • 2009
TLDR
It is found that patients with high baseline HR had an increase in serious cardiovascular events including death, hospital admission secondary to congestive heart failure, acute myocardial infarction, or revascularization procedure, and the first practical implication from the study includes that baseline HR should be recorded in addition to other risk factors such as BP and lipid profile, in the follow-up of patients with CAD.

Benefit of Heart Rate Reduction in Heart Failure

  • G. Hasenfuss
  • Medicine, Biology
    Current heart failure reports
  • 2010
TLDR
The prognostic relevance of heart rate in patients with coronary artery disease and reduced ejection fraction recently has been demonstrated in the placebo arm of the prospective BEAUTIFUL (morBidity-mortality EvAlUaTion of the If inhibitor ivabradine in patientswith coronary disease and left ventricULar dysfunction) study.

Relationship between ivabradine treatment and cardiovascular outcomes in patients with stable coronary artery disease and left ventricular systolic dysfunction with limiting angina: a subgroup analysis of the randomized, controlled BEAUTIFUL trial.

TLDR
It is raised the possibility that ivabradine may be helpful to reduce major cardiovascular events in patients with stable CAD and LVSD who present with limiting angina, however, a large-scale clinical trial is ongoing, which will formally test this hypothesis.
...

References

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Long-term prognostic value of resting heart rate in patients with suspected or proven coronary artery disease.

TLDR
High resting heart rate is a predictor for total and cardiovascular mortality independent of other risk factors in patients with stable coronary artery disease, while adjusting for risk factors.

Heart rate: an independent risk factor in cardiovascular disease

TLDR
Heart rate should be considered as an important risk factor in patients at risk of CAD or with established CAD, and treatment should be started to reduce heart rate to a normal level, similar to the aim in the treatment of patients with hypertension.

Impact of resting heart rate on outcomes in hypertensive patients with coronary artery disease: findings from the INternational VErapamil-SR/trandolapril STudy (INVEST).

TLDR
Among CAD patients with hypertension, RHR predicts adverse outcomes, and on-treatment RHR is more predictive than baseline RHR.

The BEAUTIFUL Study: Randomized Trial of Ivabradine in Patients with Stable Coronary Artery Disease and Left Ventricular Systolic Dysfunction – Baseline Characteristics of the Study Population

TLDR
Main results from BEAUTIFUL are expected in 2008, and should show whether ivabradine, on top of optimal medical treatment, reduces mortality and cardiovascular events in this population of high-risk patients.

Mode of death in heart failure: findings from the ATLAS trial

TLDR
The use of competing risks analysis on the data from the ATLAS study has identified variables associated with certain modes of death in heart failure patients that may make it possible to predict which patients might benefit most from particular therapeutic interventions.

Heart Rate and Cardiac Rhythm Relationships With Bisoprolol Benefit in Chronic Heart Failure in CIBIS II Trial

TLDR
B HR and HRC are significantly related to prognosis in heart failure and bisoprolol-induced benefit over placebo for survival was observed to a similar extent at any level of both BHR and HRC.