Among patients with left ventricular ejection fraction ≤ 35 percent attending a specialist heart failure clinic, most are treated with a beta-blocker (BB) at a dose that maintains heart rate <70 bpm, and only (at most) 16 and 12 percent respectively, require BB up-titration or treatment with ivabradine, according to a study published online in JACC: Heart Failure. However, study authors note that even in an expert clinic, opportunities to “intervene to optimize treatment are often missed.”

The study reviewed 1,000 consecutively scheduled heart failure clinic follow-up appointments over six months. Results showed that on 70 clinic visits, 58 patients with LVEF ≤35% were in sinus rhythm and had a heart rate of ≥70 bpm. Of these patients, beta-blocker dose was increased in 13, 15 were already taking target doses of BB, and 10 were reported to be intolerant of higher doses. Study investigators also noted that 20 patients were potentially eligible for, but did not receive beta-blocker up-titration. In addition, 25 patients were potentially eligible for ivabradine based on European Society of Cardiology (ESC) guidelines (14 based on UK National Institute for Health and Care Excellence (NICE) guidelines).

“In more than half of patients in whom further heart rate reduction was indicated, the indication to adjust treatment was missed,” the study investigators said. “Reluctance to up-titrate beta-blockers and insufficient awareness of heart rate as a therapeutic target in hear failure might explain this deficiency.” They urge increased education and the use of audits to raise awareness among cardiovascular professionals about the importance of managing heart rate in LVEF and sinus rhythm patients.

The U.S. Food and Drug Administration is currently evaluating ivabradine as a new drug to treat heart failure. This new study offers unique insights into the potential uptake of the drug in the patient community, and describes for the first time the prescribing patterns around beta-blocker use and titration in an outpatient setting.

Keywords: Adrenergic beta-Antagonists, Benzazepines, Follow-Up Studies, Heart Failure, Heart Rate, Outpatients, Stroke Volume, United States Food and Drug Administration

< Back to Listings