Henry Dunant Hospital, Athens, Greece.
Hellenic J Cardiol. 2012 Mar;53(2):118-26.
Significant evidence shows that elevated heart rate (HR) is an independent risk factor in patients with coronary artery disease (CAD) and influences their prognosis. In addition, patients with chronic obstructive pulmonary disease (COPD) have more frequent episodes of angina and their compliance with heart rate agents, such as beta blockers, is poor. The purpose of the multicenter observational RYTHMOS study was to evaluate the role of heart rate management in the prognosis and quality of life in patients with CAD and COPD.
Baseline data from 280 patients, enrolled in 22 hospitals representing all types of hospital and all geographical areas of the country, were analyzed. All patients had either a prior myocardial infarction or angiographically documented CAD, and COPD verified either after spirometry or from a clinical evaluation by pulmonologists.
The mean age of the enrolled patients was 71.8 ± 9.3 years, 76% were males, mean body mass index was 28.6 ± 7.9 kg/m2, 76.3% had hypertension, 31% had diabetes mellitus, and 53.5% of them suffered from heart failure. About 31% of the patients had an angina episode the week before the enrollment and the Canadian Cardiovascular Society (CSS) classification was class I, II, III and IV in 55%, 30%, 14% and 1%, respectively. The mean resting HR was 72.5 bpm; 51% of the patients had resting HR>70 bpm and 22% of them had HR80 bpm. Only 52.8% of the study patients were receiving beta-blockade (BB) therapy; they were more likely to have resting HR70 bpm (57.4% vs. 42.7%, p<0.001). 16.4% of the patients were receiving ivabradine and they had a higher initial HR compared to the others (78.5 vs. 71.3, p<0.001). Multivariate analysis showed that diabetes mellitus was independently associated with HR>70 bpm. Patients with resting HR>70 bpm had significantly more frequent angina episodes (p<0.001), were less satisfied with treatment (p<0.001), and had a lower quality of life (p<0.001).
The baseline data of this study showed that patients with CAD and COPD present inadequate HR control and frequent angina episodes. Apart from the special characteristics of these patients related to COPD management, underuse of BB therapy largely contributes to the inadequate control of HR. Patients with HR>70 bpm had significantly worse quality of life.
大量证据表明，心率（HR）升高是冠心病（CAD）患者的独立危险因素，并影响其预后。此外，慢性阻塞性肺疾病（COPD）患者心绞痛发作更为频繁，且对β受体阻滞剂等心率药物的依从性较差。多中心观察性 RYTHMOS 研究的目的是评估心率管理在 CAD 和 COPD 患者预后和生活质量中的作用。
对 280 例患者的基线数据进行分析，这些患者来自代表各种类型医院和全国所有地理区域的 22 家医院。所有患者均有心肌梗死病史或经血管造影证实的 CAD，且 COPD 经肺功能检查或肺病专家临床评估确诊。
纳入患者的平均年龄为 71.8 ± 9.3 岁，76%为男性，平均体重指数为 28.6 ± 7.9 kg/m2，76.3%患有高血压，31%患有糖尿病，53.5%患有心力衰竭。约 31%的患者在入组前一周有心绞痛发作，加拿大心血管学会（CCS）分级为 I 级、II 级、III 级和 IV 级的分别占 55%、30%、14%和 1%。静息心率为 72.5 bpm；51%的患者静息心率>70 bpm，22%的患者静息心率>80 bpm。仅有 52.8%的研究患者接受β受体阻滞剂（BB）治疗；他们更有可能静息心率为 70 bpm（57.4%比 42.7%，p<0.001）。16.4%的患者接受伊伐布雷定治疗，与其他患者相比，他们的初始心率更高（78.5 比 71.3，p<0.001）。多变量分析显示，糖尿病与静息心率>70 bpm独立相关。静息心率>70 bpm 的患者心绞痛发作更为频繁（p<0.001），对治疗的满意度更低（p<0.001），生活质量更低（p<0.001）。
本研究的基线数据显示，CAD 和 COPD 患者的心率控制不理想且心绞痛发作频繁。除了与 COPD 管理相关的这些患者的特殊特征外，β受体阻滞剂治疗的使用率低也是导致心率控制不理想的主要原因。静息心率>70 bpm 的患者生活质量明显更差。
