St James's Hospital, Dublin 8, Ireland.
Postgrad Med J. 2010 Apr;86(1014):212-7. doi: 10.1136/pgmj.2009.084384.
To examine resting heart rate (HR) in a population presenting with stable angina in relation to prior and subsequent pharmacological treatment, comorbid conditions and clinical outcome.
The European Heart Survey was a prospective, observational, cohort study of 3779 patients with stable angina newly presenting to cardiology services. Mean baseline resting HR was 73 beats/min (bpm) and 52.3% of patients had a baseline HR > 70 bpm. Over half of patients were on no chronotropic medication at baseline. Patients with chronic respiratory disease or diabetes had higher resting HRs (75-76 bpm), and were more likely to have been receiving calcium channel blockers at baseline assessment. Overall, beta-blockers were the most common treatment administered following cardiologist assessment, but were used less frequently in patients with chronic respiratory disease and diabetes, and the dosages used were less than that found to be effective in clinical trials. Mean daily doses of metoprolol, bisoprolol, carvedilol, and atenolol were 75 mg, 6 mg, 19 mg and 55 mg, respectively. Higher HR at baseline was associated with higher rates of cardiovascular mortality and hospitalisation for heart failure.
Control of ischaemic symptoms through heart rate modification in patients with angina is currently inadequate, both by primary referring physicians and cardiologists. Given the adverse outcome associated with higher resting heart rates in this as in other studies, and the availability of specific HR reducing strategies, attention should be given to achieving optimal HR control.
研究稳定型心绞痛患者静息心率（HR）与既往和后续药物治疗、合并症及临床结局的关系。
欧洲心脏调查是一项前瞻性、观察性、队列研究，纳入了 3779 例新出现稳定型心绞痛的患者。患者的平均基线静息 HR 为 73 次/分（bpm），52.3%的患者基线 HR>70bpm。超过一半的患者在基线时没有使用变时药物。患有慢性呼吸系统疾病或糖尿病的患者静息 HR 较高（75-76bpm），且在基线评估时更可能接受钙通道阻滞剂治疗。总体而言，β受体阻滞剂是在心脏病专家评估后最常使用的治疗药物，但在患有慢性呼吸系统疾病和糖尿病的患者中使用频率较低，且使用剂量低于临床试验中发现的有效剂量。美托洛尔、比索洛尔、卡维地洛和阿替洛尔的平均日剂量分别为 75mg、6mg、19mg 和 55mg。基线时 HR 较高与心血管死亡率和心力衰竭住院率较高相关。
目前，通过心率调节来控制心绞痛患者的缺血症状，无论是初级转诊医生还是心脏病专家，都做得不够。鉴于其他研究中也发现较高静息心率与不良结局相关，且存在特定的降低心率策略，应关注实现最佳 HR 控制。
