Physicians' Academy for Cardiovascular Education
Reducing heart rate benefits HF patients in sinus rhythm, but not those with AF

Reducing heart rate benefits HF patients in sinus rhythm, but not those with AF

News - Apr. 30, 2017

Paris, France | Targeting heart rate to improve mortality in heart failure with reduced ejection fraction: a comparison of sinus rhythm and atrial fibrillation

Presented at ESC Heart Failure 2017 by John CLELAND (London, United Kingdom), on behalf of the Beta-blockers in Heart Failure Collaborative Group


Individual patient data of eleven randomised controlled trials (MDC 1993, CIBIS 1994, US-HF 1996, ANZ 1997, CIBIS-II 1999, MERIT-HF 1999, COPERNICUS 2001, CAPRICORN 2001, BEST 2001, CHRISTMAS 2003 and SENIORS 2005) were pooled, amounting to data of 18637 HF patients. All RCTs had mortality as a major trial endpoint, were unconfounded head-to-head trials, and had planned follow-up of over 6 months, and included at least 300 patients.

The aim was to compare the effect of betablocker use in patients in sinus rhythm with those with atrial fibrillation (AF). At baseline, it was noted that those in the higher heart rate category (>90 bpm) were slightly sicker, with a larger proportion having HF NYHA class III/IV, and a lower LVEF, while age was somewhat lower than in the other two heart rate categories (<70 and 70-90 bpm).

Main results


Thus, these pooled data show that higher baseline heart rate is associated with higher mortality in sinus rhythm, but makes no difference in AF. A higher dose of betablocker (and of placebo!) is associated with lower mortality in sinus rhythm, and a lower attained heart rate is associated with lower mortality in sinus rhythm, but does not affect mortality in AF.

Heart rate turned out not to be a good predictor of response to treatment with a betablocker, as efficacy was similar in all heart rate categories. Thus, Dr. Cleland concluded that in clinical practice, it is important to not only attain the proper dose of betablocker, but also to lower heart rate, possibly with an additional agent. In AF, there is little evidence to expect a benefit.


Our coverage of ESC HF 2017 is based on the information provided during the congress.

The data have been published in J Am Coll Cardiol

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