Table 4.
Medications and physicians’ opinion regarding a HR ≤70 vs. >70 bpm in patients with sinus rhythm and EF <40%
| Variable | ≤70 bpm (n = 143) | >70 bpm (n = 73) | p value |
|---|---|---|---|
| Beta-blockers | 138 (96.5%) | 70 (95.9%) | 1.00 |
| Beta-blockers (name) | |||
| Atenolol | 1 (0.7%) | 0 (0.0%) | |
| Bisoprolol | 53 (37.1%) | 31 (42.5%) | |
| Carvedilol | 12 (8.4%) | 2 (2.7%) | |
| Metoprolol | 72 (50.3%) | 37 (50.7%) | |
| Not using | 5 (3.5%) | 3 (4.1%) | 0.51 |
| Reasons for not using BBs | |||
| Low blood pressure | 0 (0.0%) | 1 (1.4%) | 0.68 |
| Dizziness | 1 (0.7%) | 1 (1.4%) | 1.00 |
| Raynaud/Claudio | 0 (0.0%) | 1 (1.4%) | 0.68 |
| Pulmonary disease | 0 (0.0%) | 0 (0.0%) | 1.00 |
| Fatigue | 0 (0.0%) | 2 (2.7%) | 0.23 |
| Bradycardia | 5 (3.5%) | 0 (0.0%) | 0.25 |
| Asthma | 0 (0.0%) | 0 (0.0%) | 1.00 |
| Decompensation | 0 (0.0%) | 0 (0.0%) | 1.00 |
| No indication | 0 (0.0%) | 0 (0.0%) | 1.00 |
| Other | 1 (0.7%) | 1 (1.4%) | 1.00 |
| BB dose reached | |||
| ≥50 target dosea | 99 (72.8%) | 56 (80.0%) | 0.34 |
| Target dosea | 52 (38.2%) | 28 (40.0%) | 0.92 |
| >Target dosea | 2 (1.5%) | 0 (0.0%) | 0.87 |
| The maximum tolerated dose (physician´s opinion) | 129 (93.5%) | 59 (84.3%) | 0.066 |
| Reasons for not achieving BB target dose | |||
| Low blood pressure | 32 (23.2%) | 15 (21.4%) | 0.92 |
| Fatigue | 12 (8.7%) | 8 (11.4%) | 0.69 |
| Dyspnea | 3 (2.2%) | 0 (0.0%) | 0.58 |
| Dizziness | 11 (8.0%) | 9 (12.9%) | 0.38 |
| Bradycardia | 30 (21.7%) | 3 (4.3%) | 0.0010 |
| Other | 14 (10.1%) | 10 (14.3%) | 0.51 |
| BB tolerated (on treatment with BB) | |||
| No report of side effects | 87 (60.8%) | 44 (60.3%) | 1.00 |
| Nightmares as side effect | 5 (3.5%) | 2 (2.7%) | 1.00 |
| Cold extremities as side effect | 16 (11.2%) | 3 (4.1%) | 0.13 |
| Impotence as side effect | 16 (11.2%) | 2 (2.7%) | 0.049 |
| Depression as side effect | 2 (1.4%) | 5 (6.8%) | 0.090 |
| Tiredness as side effect | 26 (18.2%) | 17 (23.3%) | 0.48 |
| Other side effects | 3 (2.1%) | 2 (2.7%) | 1.00 |
| BB up-titration done at | |||
| Department of Cardiology | 110 (80.3%) | 59 (83.1%) | |
| Department of Medicine | 22 (16.1%) | 11 (15.5%) | |
| Primary care | 5 (3.6%) | 1 (1.4%) | 0.65 |
| BB duration (years) | 3.60 (4.55) 1.50 (0.00; 19.80) n = 138 |
3.01 (4.31) 1.30 (0.00; 18.10) n = 69 |
0.055 |
| RAAS | 140 (97.9%) | 69 (94.5%) | 0.35 |
| ACE inhibitors | 92 (64.3%) | 44 (60.3%) | 0.66 |
| ARB | 51 (35.7%) | 26 (35.6%) | 1.00 |
| ACE inhibitors (name) | |||
| Enalapril | 24 (16.8%) | 19 (26.0%) | |
| Lisinopril | 0 (0.0%) | 1 (1.4%) | |
| Not using | 51 (35.7%) | 29 (39.7%) | |
| Ramipril | 68 (47.6%) | 24 (32.9%) | 0.082 |
| ARB (name) | |||
| Candesartan | 38 (26.6%) | 18 (24.7%) | |
| Irbesartan | 0 (0.0%) | 2 (2.7%) | |
| Losartan | 11 (7.7%) | 5 (6.8%) | |
| Not using A | 92 (64.3%) | 47 (64.4%) | |
| Valsartan | 2 (1.4%) | 1 (1.4%) | 0.40 |
| ACE reached the maximum tolerated dose (physician’s opinion) | 86 (93.5%) | 36 (81.8%) | 0.080 |
| ARB reached the maximum tolerated dose (physician’s opinion) | 43 (82.7%) | 23 (82.1%) | 1.00 |
| RAAS reached the maximum tolerated dose (physician’s opinion) | 125 (89.3%) | 56 (81.2%) | 0.16 |
| MRA | 84 (58.7%) | 42 (57.5%) | 0.98 |
| MRA reached the maximum tolerated dose (physician’s opinion) | 74 (88.1%) | 39 (92.9%) | 0.62 |
| Other treatments | |||
| Loop diuretics | 79 (55.2%) | 40 (54.8%) | 1.00 |
| Digitalis | 4 (2.8%) | 3 (4.1%) | 0.88 |
| Statin | 94 (65.7%) | 42 (57.5%) | 0.30 |
| Nitrate | 17 (11.9%) | 7 (9.6%) | 0.79 |
| Other thrombin inhibitors | 26 (18.2%) | 16 (21.9%) | 0.63 |
| ASA | 78 (54.5%) | 38 (52.1%) | 0.84 |
| Anticoagulants | 25 (17.5%) | 12 (16.4%) | 1.00 |
| Antiarrhythmics other than BB | 3 (2.1%) | 2 (2.7%) | 1.00 |
| Ivabradine/procoralan | 3 (2.1%) | 6 (8.2%) | 0.084 |
| Allopur/probenecid | 19 (13.3%) | 3 (4.1%) | 0.051 |
| Device treatments | |||
| Conventional pacemaker | 3 (2.1%) | 6 (8.2%) | 0.084 |
| CRT | 20 (14.0%) | 9 (12.3%) | 0.91 |
| ICD | 28 (19.6%) | 18 (24.7%) | 0.49 |
| Clinical assessment | |||
| Physician considers patient having too low heart rate | 4 (2.8%) | 1 (1.4%) | 0.90 |
| Physician considers patient being optimally treated | 129 (90.2%) | 36 (49.3%) | <0.0001 |
| Physician considers patient having too high heart rate | 10 (7.0%) | 36 (49.3%) | <0.0001 |
a Target dose is calculated only for patients using metoprolol (target = 200 mg), carvedilol (target = 50 mg), and bisoprolol (target = 10 mg)