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How Heart Rate Should Be Controlled in Patients with Atherosclerosis and Heart Failure

Current Atherosclerosis Reports volume 20, Article number: 54 (2018) Cite this article

Abstract

Purpose of Review

Resting heart rate is an independent risk factor for all-cause and cardiovascular mortality in patients with heart failure. The main objectives are to discuss the prognosis of heart rate, its association with coronary atherosclerosis, and the modalities of control of the heart rate in sinus rhythm and in the rhythm of atrial fibrillation in patients with chronic heart failure.

Recent Findings

As a therapeutic option for control heart rate, medications such as beta-blockers, digoxin, and finally ivabradine have been studied. Non-dihydropyridine calcium channel blockers are contraindicated in patients with heart failure and reduced ejection fraction. The influence of the magnitude of heart rate reduction and beta-blocker dose on morbidity and mortality will be discussed. Regarding the patients with heart failure and atrial fibrillation, there are different findings in heart rate control with the use of a beta-blocker. Patients eligible for ivabradine have clinical benefits and increased ejection fraction. Vagal nerve stimulation has low efficacy for the control of heart rate. Complementary therapies such as tai chi and yoga showed no effect on heart rate.

Summary

In this review, we discuss the main therapeutic options for the control of heart rate in patients with atherosclerosis and heart failure. More research is needed to examine the effects of therapeutic options for heart rate control in different population types, as well as their effects on clinical outcomes and impact on morbidity and mortality.

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Affiliations

  1. Department of Internal Medicine, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil

    Rose Mary Ferreira Lisboa da Silva

  2. Master Institute of Education President Antonio Carlos, IMEPAC, Araguari, Brazil

    Anaisa Silva Roever Borges

  3. Department of Clinical Research, Federal University of Uberlandia, Uberlândia, Brazil

    Nilson Penha Silva, Elmiro Santos Resende & Leonardo Roever

  4. Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China

    Gary Tse

  5. Faculty of Medicine, Li KaShing Institute of Health Sciences, Chinese University of Hong Kong, Hong Kong, China

    Gary Tse

  6. Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, the Second Hospital of Tianjin Medical University, Tianjin, China

    Tong Liu

  7. Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy

    Giuseppe Biondi-Zoccai

  8. Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Italy

    Giuseppe Biondi-Zoccai

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  1. Rose Mary Ferreira Lisboa da Silva
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Rose Mary Ferreira Lisboa da Silva, Anaisa Silva Roever Borges, Nilson Penha Silva, Elmiro Santos Resende, Gary Tse, Tong Liu, Leonardo Roever, and Giuseppe Biondi-Zoccai declare no conflict of interest.

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da Silva, R.M.F.L., Borges, A.S.R., Silva, N.P. et al. How Heart Rate Should Be Controlled in Patients with Atherosclerosis and Heart Failure. Curr Atheroscler Rep 20, 54 (2018). https://doi.org/10.1007/s11883-018-0757-3

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  • DOI: https://doi.org/10.1007/s11883-018-0757-3

Keywords

  • Heart rate
  • Systolic heart failure
  • Mortality
  • Beta-blocker
  • Ivabradine