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Heart Rate or Beta-Blocker Dose? Association With Outcomes in Ambulatory Heart Failure Patients With Systolic Dysfunction: Results From the HF-ACTION Trial.
JACC Heart Fail 2016; 4(2):109-115JH

Abstract

OBJECTIVES

This study aimed to compare whether reduced heart rate (HR) or higher beta-blocker (BB) dose affected outcomes to a greater extent in the HF-ACTION (Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training) trial population.

BACKGROUND

Recent data have shown that HR is an important modifiable factor in reducing mortality in heart failure (HF) patients. It has also been shown that titration of doses of BBs improves outcomes of morbidity and mortality in chronic HF patients with reduced ejection fraction. We aimed to compare whether reduced HR or higher BB dose affected outcomes to a greater extent in the HF-ACTION trial population.

METHODS

HF-ACTION was a randomized, multicenter trial enrolling 2,331 ambulatory HF patients with systolic dysfunction (New York Heart Association functional class II to IV, left ventricular ejection fraction <0.35) randomized to exercise training versus usual care, with median follow-up of 2.5 years. BB dose at baseline was standardized by use of carvedilol equivalents. BB dose and HR were analyzed by discrete groups (higher/lower dose; higher/lower HR). The relationship of BB dose, HR, and the primary endpoint of all-cause mortality or all-cause hospitalization and other cardiovascular secondary endpoints were determined before and after adjustment for variables found to be significantly associated with outcome in the HF-ACTION cohort.

RESULTS

There was a significant inverse relationship between either BB dose (higher was better) or HR (lower was better) and all-cause death or hospitalization in unadjusted analysis; however, only BB dose was significant for improved mortality outcomes. After adjustment for other predictors of outcome, only BB dose remained significant for improving all-cause death or hospitalization. BB dose, but not HR, was associated with improved outcomes of other cardiovascular endpoints in unadjusted analysis but did not remain significant when adjusted for other predictors of outcome in this cohort.

CONCLUSIONS

There were more associated improvements in outcomes with higher BB dose than with reduced HR in this well-treated HF cohort with systolic dysfunction, which suggests that titration of BB doses may confer a greater benefit than reduction of HR in such patients. (Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training [HF-ACTION]; NCT00047437).

Authors+Show Affiliations

Duke University and Duke Clinical Research Institute, Durham, North Carolina. Electronic address: mona.fiuzat@duke.edu.Duke University and Duke Clinical Research Institute, Durham, North Carolina.Montefiore Einstein Center for Heart and Vascular Care, Bronx, New York.University of North Carolina, Chapel Hill, North Carolina.Thomas Jefferson University, Philadelphia, Pennsylvania.Duke University and Duke Clinical Research Institute, Durham, North Carolina; Inova Heart & Vascular Institute, Falls Church, Virginia.

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial

Language

eng

PubMed ID

26519996

Citation

Fiuzat, Mona, et al. "Heart Rate or Beta-Blocker Dose? Association With Outcomes in Ambulatory Heart Failure Patients With Systolic Dysfunction: Results From the HF-ACTION Trial." JACC. Heart Failure, vol. 4, no. 2, 2016, pp. 109-115.
Fiuzat M, Wojdyla D, Pina I, et al. Heart Rate or Beta-Blocker Dose? Association With Outcomes in Ambulatory Heart Failure Patients With Systolic Dysfunction: Results From the HF-ACTION Trial. JACC Heart Fail. 2016;4(2):109-115.
Fiuzat, M., Wojdyla, D., Pina, I., Adams, K., Whellan, D., & O'Connor, C. M. (2016). Heart Rate or Beta-Blocker Dose? Association With Outcomes in Ambulatory Heart Failure Patients With Systolic Dysfunction: Results From the HF-ACTION Trial. JACC. Heart Failure, 4(2), pp. 109-115. doi:10.1016/j.jchf.2015.09.002.
Fiuzat M, et al. Heart Rate or Beta-Blocker Dose? Association With Outcomes in Ambulatory Heart Failure Patients With Systolic Dysfunction: Results From the HF-ACTION Trial. JACC Heart Fail. 2016;4(2):109-115. PubMed PMID: 26519996.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Heart Rate or Beta-Blocker Dose? Association With Outcomes in Ambulatory Heart Failure Patients With Systolic Dysfunction: Results From the HF-ACTION Trial. AU - Fiuzat,Mona, AU - Wojdyla,Daniel, AU - Pina,Ileana, AU - Adams,Kirkwood, AU - Whellan,David, AU - O'Connor,Christopher M, Y1 - 2015/10/28/ PY - 2015/06/10/received PY - 2015/08/19/revised PY - 2015/09/14/accepted PY - 2015/11/2/entrez PY - 2015/11/2/pubmed PY - 2016/11/2/medline KW - beta-blockers KW - dose KW - exercise KW - heart failure KW - heart rate KW - mortality SP - 109 EP - 115 JF - JACC. Heart failure JO - JACC Heart Fail VL - 4 IS - 2 N2 - OBJECTIVES: This study aimed to compare whether reduced heart rate (HR) or higher beta-blocker (BB) dose affected outcomes to a greater extent in the HF-ACTION (Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training) trial population. BACKGROUND: Recent data have shown that HR is an important modifiable factor in reducing mortality in heart failure (HF) patients. It has also been shown that titration of doses of BBs improves outcomes of morbidity and mortality in chronic HF patients with reduced ejection fraction. We aimed to compare whether reduced HR or higher BB dose affected outcomes to a greater extent in the HF-ACTION trial population. METHODS: HF-ACTION was a randomized, multicenter trial enrolling 2,331 ambulatory HF patients with systolic dysfunction (New York Heart Association functional class II to IV, left ventricular ejection fraction <0.35) randomized to exercise training versus usual care, with median follow-up of 2.5 years. BB dose at baseline was standardized by use of carvedilol equivalents. BB dose and HR were analyzed by discrete groups (higher/lower dose; higher/lower HR). The relationship of BB dose, HR, and the primary endpoint of all-cause mortality or all-cause hospitalization and other cardiovascular secondary endpoints were determined before and after adjustment for variables found to be significantly associated with outcome in the HF-ACTION cohort. RESULTS: There was a significant inverse relationship between either BB dose (higher was better) or HR (lower was better) and all-cause death or hospitalization in unadjusted analysis; however, only BB dose was significant for improved mortality outcomes. After adjustment for other predictors of outcome, only BB dose remained significant for improving all-cause death or hospitalization. BB dose, but not HR, was associated with improved outcomes of other cardiovascular endpoints in unadjusted analysis but did not remain significant when adjusted for other predictors of outcome in this cohort. CONCLUSIONS: There were more associated improvements in outcomes with higher BB dose than with reduced HR in this well-treated HF cohort with systolic dysfunction, which suggests that titration of BB doses may confer a greater benefit than reduction of HR in such patients. (Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training [HF-ACTION]; NCT00047437). SN - 2213-1787 UR - https://www.unboundmedicine.com/medline/citation/26519996/Heart_Rate_or_Beta_Blocker_Dose_Association_With_Outcomes_in_Ambulatory_Heart_Failure_Patients_With_Systolic_Dysfunction:_Results_From_the_HF_ACTION_Trial_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S2213-1779(15)00558-2 DB - PRIME DP - Unbound Medicine ER -