Hospital Santa Marcelina - Cardiologia, São Paulo, SP - Brazil.
Arq Bras Cardiol. 2020 Dec;115(6):1063-1069. doi: 10.36660/abc.20190090.
Studies have shown that heart failure (HF) patients with heart rate (HR) < 70 bpm have had a better clinical outcome and lower morbidity and mortality compared with those with HR > 70 bpm. However, many HF patients maintain an elevated HR.
To evaluate HR and the prescription of medications known to reduce mortality in HF patients attending an outpatient cardiology clinic.
We consecutively evaluated patients seen in an outpatient cardiology clinic, aged older than 18 years, with diagnosis of HF and left ventricular ejection fraction (LVEF) < 45%. Patients with sinus rhythm were divided into two groups - HR ≤ 70 bpm (G1) and HR > 70 bpm (G2). The Student's t-test and the chi-square test were used in the statistical analysis, and a p-value < 0.05 was considered statistically significant. The SPSS software was used for the analyses.
A total of 212 consecutive patients were studied; 41 (19.3%) had atrial fibrillation or had a pacemaker implanted and were excluded from the analysis, yielding 171 patients. Mean age of patients was 63.80 ± 11.77 years, 59.6% were men, and mean LVEF 36.64±7.79%. The most prevalent HF etiology was ischemic (n=102; 59.6%), followed by Chagasic (n=17; 9.9%). One-hundred thirty-one patients (76.6%) were hypertensive and 63 (36.8%) diabetic. Regarding HR, 101 patients had a HR ≤70 bpm (59.1%) and 70 patients (40.93%) had a HR >70 bpm (G2). Mean HR of G1 and G2 was 61.5±5.3 bpm and 81.8±9.5 bpm, respectively (p<0.001). Almost all patients (98.8%) were receiving carvedilol, prescribed at a mean dose of 42.1±18.5 mg/day in G1 and 42.5±21.1mg/day in G2 (p=0.911). Digoxin was used in 5.9% of patients of G1 and 8.5% of G2 (p=0.510). Mean dose of digoxin in G1 and G2 was 0.19±0.1 mg/day and 0.19±0.06 mg/day, respectively (p=0,999). Most patients (87.7%) used angiotensin converting enzyme inhibitors (ACEI) or angiotensin II receptor blockers (ARB), and 56.7% used spironolactone. Mean dose of enalapril was 28.9±12.7 mg/day and mean dose of ARB was 87.8±29.8 mg/day. The doses of ACEI and ARB were adequate in most of patients.
The study revealed that HR of 40.9% of patients with HF was above 70 bpm, despite treatment with high doses of beta blockers. Further measures should be applied for HR control in HF patients who maintain an elevated rate despite adequate treatment with beta blocker. (Arq Bras Cardiol. 2020; 115(6):1063-1069).
研究表明，与心率（HR）>70 次/分的心力衰竭（HF）患者相比，心率（HR）<70 次/分的 HF 患者具有更好的临床结局和更低的发病率和死亡率。然而，许多 HF 患者的 HR 仍然升高。
评估在就诊于心内科门诊的 HF 患者中 HR 及已知降低 HF 患者死亡率的药物的处方情况。
我们连续评估了在门诊心内科就诊的年龄大于 18 岁、HF 诊断和左心室射血分数（LVEF）<45%的患者。窦性心律患者分为两组——HR≤70 次/分（G1）和 HR>70 次/分（G2）。统计分析采用学生 t 检验和卡方检验，p 值<0.05 认为具有统计学意义。采用 SPSS 软件进行分析。
共纳入 212 例连续患者；41 例（19.3%）患者患有房颤或植入起搏器，排除在分析之外，最终纳入 171 例患者。患者平均年龄为 63.80±11.77 岁，59.6%为男性，平均 LVEF 为 36.64±7.79%。最常见的 HF 病因是缺血性（n=102；59.6%），其次是恰加斯病（n=17；9.9%）。131 例（76.6%）患者为高血压，63 例（36.8%）患者为糖尿病。关于 HR，101 例患者的 HR≤70 次/分（59.1%），70 例患者的 HR>70 次/分（G2）。G1 和 G2 的平均 HR 分别为 61.5±5.3 次/分和 81.8±9.5 次/分（p<0.001）。几乎所有患者（98.8%）均服用卡维地洛，G1 组的平均剂量为 42.1±18.5mg/天，G2 组为 42.5±21.1mg/天（p=0.911）。G1 组有 5.9%的患者使用地高辛，G2 组有 8.5%的患者使用地高辛（p=0.510）。G1 和 G2 组地高辛的平均剂量分别为 0.19±0.1mg/天和 0.19±0.06mg/天（p=0.999）。大多数患者（87.7%）使用血管紧张素转换酶抑制剂（ACEI）或血管紧张素 II 受体阻滞剂（ARB），56.7%使用螺内酯。依那普利的平均剂量为 28.9±12.7mg/天，ARB 的平均剂量为 87.8±29.8mg/天。大多数患者 ACEI 和 ARB 的剂量充足。
本研究显示，尽管 HF 患者接受了高剂量的β受体阻滞剂治疗，但仍有 40.9%的患者 HR>70 次/分。对于尽管接受了β受体阻滞剂充分治疗但 HR 仍升高的 HF 患者，应采取进一步的措施来控制 HR。（Arq Bras Cardiol. 2020; 115(6):1063-1069）。
