In-hospital Heart Rate Reduction With Beta Blockers and Ivabradine Early After Recovery in Patients With Acute Decompensated Heart Failure Reduces Short-Term Mortality and Rehospitalization

Frontiers in Cardiovascular Medicine

Francesco Paolo Lo Muzio¹  Heiner Post²  Carlo Campana³  Alessio Alogna⁵  Giuseppe Di Tano⁶  Mauro Gori⁷  Caterina De Carlini⁸  Daniel Nassiacos⁹  Dawud Abawi^1,10  Giada Confortola^1,10  Konstantinos Rapis^1,10  Alessandro Faragli^1,11  Burkert Pieske^1,11  Sebastian Kelle^1,11 

[1] 0Department of Medicine and Surgery, University of Parma, Parma, Italy;1Department of Cardiology, Contilia Heart and Vessel Centre, St. Marien-Hospital Mülheim, Mülheim, Germany;2Department of Cardiology Sant'Anna Hospital, ASST-Lariana, Como, Italy;Berlin Institute of Health, Berlin, Germany;DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany;Department of Cardiology Ospedale Maggiore, ASST Cremona, Cremona, Italy;Department of Cardiology, ASST Ospedale Papa Giovanni XXXIII, Bergamo, Italy;Department of Cardiology, Merate Hospital, ASST-Lecco, Lecco, Italy;Department of Cardiology, Ospedale di Circolo, ASST Valle Olona, Saronno VA, Italy;Department of Internal Medicine and Cardiology, Campus Virchow-Klinikum, Charité – Universitätsmedizin Berlin, Berlin, Germany;Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany;Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, Verona, Italy;

关键词: heart failure;    observational study;    risk stratification;    therapy;    heart rate;   

DOI  :  10.3389/fcvm.2021.665202

来源: DOAJ

【 摘 要 】

Objective: In the past years, heart rate (HR) has emerged as a highly relevant modifiable risk factor for heart failure (HF) patients. However, most of the clinical trials so far evaluated the role of HR in stable chronic HF cohorts. The aim of this multi-center, prospective observational study was to assess the association between HR and therapy with HR modulators (beta blockers, ivabradine, or a combination of ivabradine and beta blockers) at hospital discharge with patients' cardiovascular mortality and re-hospitalization at 6 months in acutely decompensated HF patients.Materials and Methods: We recruited 289 HF patients discharged alive after admission for HF decompensation from 10 centers in northern Italy over 9 months (from April 2017 to January 2018). The primary endpoint was the combination of cardiovascular mortality or re-hospitalizations for HF at 6 months.Results: At 6 months after discharge, 64 patients were readmitted (32%), and 39 patients died (16%). Multivariate analysis showed that HR at discharge ≥ 90 bpm (OR = 8.47; p = 0.016) independently predicted cardiovascular mortality, while therapy with beta blockers at discharge was found to reduce the risk of the composite endpoint. In patients receiving HR modulators the event rates for the composite endpoint, all-cause mortality, and cardiovascular mortality were lower than in patients not receiving HR modulators.Conclusions: Heart rate at discharge ≥90 bpm predicts cardiovascular mortality, while therapy with beta blockers is negatively associated with the composite endpoint of cardiovascular mortality and hospitalization at 6 months in acutely decompensated HF patients. Patients receiving a HR modulation therapy at hospital discharge showed the lowest rate of cardiovascular mortality and re-hospitalization.

【 授权许可】

Unknown