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High Heart Rate: A Predictor of Heart Failure in Healthy Subjects and a Risk Factor for Adverse Outcome in Patients with Heart Failure

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Hypertension and Heart Failure

Part of the book series: Updates in Hypertension and Cardiovascular Protection ((UHCP))

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Abstract

Heart failure (HF) is characterized by neurohumoral activation of the sympathetic nervous system, which is accompanied by increased heart rate (HR), myocardial contractility, and vascular tone. The compensatory increase in heart rate associated with heart failure causes increased myocardial oxygen consumption, decreased coronary blood flow, and reduced myocardial efficiency. Several randomized controlled trials (RCTs) performed with beta-blockers have provided undisputed evidence for a beneficial effect of heart rate reduction in patients with heart failure with reduced ejection fraction (HFrEF). These results led the European guidelines to recommend bisoprolol, carvedilol, metoprolol succinate CR/XL, or nebivolol as first-line drugs for the treatment of patients with heart failure. Whether beta-blockers may also be beneficial in patients with heart failure with preserved ejection fraction (HFpEF) is not well-known. Ivabradine, on top of standard beta-blocking therapy, improved prognosis in patients from the Systolic Heart Failure Treatment with the I(f) Inhibitor Ivabradine Trial (SHIFT) study. However, this effect was observed in patients with a heart rate ≥ 75 bpm but not in those with a lower heart rate. These findings emphasize the importance of identifying heart failure patients with a high heart rate because they can benefit the most from pharmacological heart rate reduction. However, it is not known whether the lower the heart rate the better the outcome, and the current guidelines do not provide specific suggestions about this issue.

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Authors and Affiliations

  1. Department of Medicine, Studium Patavinum, University of Padova, Padua, Italy

    Paolo Palatini

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  1. Paolo Palatini
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Correspondence to Paolo Palatini .

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Editors and Affiliations

  1. Carol Davila University of Medicine and Pharmacy, Bucharest, Bucuresti, Romania

    Maria Dorobantu

  2. Department of Pharmacology, Toxicology and Clinical Psychopharmacology Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania

    Victor Voicu

  3. University of Milano-Bicocca, Milano, Italy

    Guido Grassi

  4. Dept of Clinical and Experimental Sci, University of Brescia, Brescia, Italy

    Enrico Agabiti-Rosei

  5. University of Milano-Bicocca, Milano, Italy

    Giuseppe Mancia

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Palatini, P. (2023). High Heart Rate: A Predictor of Heart Failure in Healthy Subjects and a Risk Factor for Adverse Outcome in Patients with Heart Failure. In: Dorobantu, M., Voicu, V., Grassi, G., Agabiti-Rosei, E., Mancia, G. (eds) Hypertension and Heart Failure. Updates in Hypertension and Cardiovascular Protection. Springer, Cham. https://doi.org/10.1007/978-3-031-39315-0_5

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  • DOI: https://doi.org/10.1007/978-3-031-39315-0_5

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