Department of Internal Medicine, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil.
Master Institute of Education President Antonio Carlos, IMEPAC, Araguari, Brazil.
Curr Atheroscler Rep. 2018 Sep 17;20(11):54. doi: 10.1007/s11883-018-0757-3.
Resting heart rate is an independent risk factor for all-cause and cardiovascular mortality in patients with heart failure. The main objectives are to discuss the prognosis of heart rate, its association with coronary atherosclerosis, and the modalities of control of the heart rate in sinus rhythm and in the rhythm of atrial fibrillation in patients with chronic heart failure.
As a therapeutic option for control heart rate, medications such as beta-blockers, digoxin, and finally ivabradine have been studied. Non-dihydropyridine calcium channel blockers are contraindicated in patients with heart failure and reduced ejection fraction. The influence of the magnitude of heart rate reduction and beta-blocker dose on morbidity and mortality will be discussed. Regarding the patients with heart failure and atrial fibrillation, there are different findings in heart rate control with the use of a beta-blocker. Patients eligible for ivabradine have clinical benefits and increased ejection fraction. Vagal nerve stimulation has low efficacy for the control of heart rate. Complementary therapies such as tai chi and yoga showed no effect on heart rate. In this review, we discuss the main therapeutic options for the control of heart rate in patients with atherosclerosis and heart failure. More research is needed to examine the effects of therapeutic options for heart rate control in different population types, as well as their effects on clinical outcomes and impact on morbidity and mortality.
静息心率是心力衰竭患者全因和心血管死亡率的独立危险因素。主要目的是讨论心率的预后及其与冠状动脉粥样硬化的关系，以及控制窦性节律和心房颤动节律下慢性心力衰竭患者心率的方式。
作为控制心率的治疗选择，已经研究了β受体阻滞剂、地高辛和伊伐布雷定等药物。非二氢吡啶类钙通道阻滞剂在心力衰竭和射血分数降低的患者中是禁忌的。将讨论心率降低幅度和β受体阻滞剂剂量对发病率和死亡率的影响。对于心力衰竭和心房颤动患者，β受体阻滞剂在控制心率方面有不同的发现。有资格使用伊伐布雷定的患者具有临床获益和射血分数增加。迷走神经刺激对控制心率的效果较低。补充疗法，如太极和瑜伽，对心率没有影响。在这篇综述中，我们讨论了控制动脉粥样硬化和心力衰竭患者心率的主要治疗选择。需要进一步研究不同人群类型的心率控制治疗选择的效果，以及它们对临床结局的影响和对发病率和死亡率的影响。
