Department of Cardiology, the Second Hospital of Hebei Medical University, Shijiazhuang-China.
Anatol J Cardiol. 2021 Nov;25(11):762-773. doi: 10.5152/AnatolJCardiol.2021.90.
On evaluating the guidelines from previous studies, we found no randomized controlled trials on the use of beta-blockers for heart failure (HF) that employed as evidence for heart rate targets of 60 or 70 beats/min. In this study, we aimed to assess the target heart rate in patients with HF treated with beta-blockers.
We used the keywords, “heart failure” and “beta-blocker” to search PubMed, Ovid, EMBASE, and Cochrane from 1966 to June 2021. Two authors independently reviewed the results of the search strategy and selected all the studies that reported the effect of beta-blockers on all-cause mortality in patients with HFrEF. We conducted analyses using Review Manager, version 5.0 and Stata version 12.0. Risk of bias was assessed regarding randomization, allocation sequence concealment, blinding, incomplete outcome data, and other biases. Sensitivity analysis was carried out to compare the results of fixed effect model with the results of random effect.
No clinical trial supported the optimal heart rate of 60 beats/min. Risk ratio (RR) and 95% confidence interval (CI) were 0.77 (0.71, 0.83) and 0.86 (0.76, 0.97) in the subgroup with a baseline heart rate >80 beats/min and subgroup with baseline of ≤80 beats/min, respectively. RR and 95% CI were 0.92 (0.82, 1.02) and 0.77 (0.65, 0.92) in 2 subgroups with heart rate controlled ≥70 beats/min and 60–70 beats/min, respectively. Accumulated to MOCHA 1 trial (heart rate controlled 70 beats/min), there was no significant difference in mortality between the experimental group and the control group (RR=0.91, 95% CI 0.82–1.02). Accumulated to SENIORS trial (heart rate controlled 68.8 beats/min), there was a difference in mortality between the experimental and the control groups (RR=0.90, 95% CI 0.82–0.99).
The main effect of beta-blockers in the treatment of HF is achieved by lowering heart rate. The use of beta-blockers did not benefit in people with HFrEF whose heart rate was 77 beats/min before they started the treatment regimen. In patients with HFrEF, the purpose of beta-blockers is to control the heart rate to 65–70 beats min.
在评估以往研究的指南时，我们发现没有关于β受体阻滞剂治疗心力衰竭（HF）时使用心率目标为 60 或 70 次/分的随机对照试验作为证据。本研究旨在评估 HF 患者接受β受体阻滞剂治疗时的目标心率。
我们使用关键词“心力衰竭”和“β受体阻滞剂”在 PubMed、Ovid、EMBASE 和 Cochrane 数据库中检索 1966 年至 2021 年 6 月的文献。两位作者独立回顾了检索策略的结果，并选择了所有报告β受体阻滞剂对射血分数降低的心力衰竭（HFrEF）患者全因死亡率影响的研究。我们使用 Review Manager 版本 5.0 和 Stata 版本 12.0 进行分析。评估了随机分组、分配序列隐藏、盲法、结局数据不完整和其他偏倚的风险。进行敏感性分析以比较固定效应模型和随机效应模型的结果。
没有临床试验支持最佳心率为 60 次/分。基础心率>80 次/分亚组和基础心率≤80 次/分亚组的风险比（RR）和 95%置信区间（CI）分别为 0.77（0.71，0.83）和 0.86（0.76，0.97）。基础心率控制在≥70 次/分和 60-70 次/分亚组的 RR 和 95%CI 分别为 0.92（0.82，1.02）和 0.77（0.65，0.92）。累积 MOCHA1 试验（心率控制在 70 次/分），实验组与对照组之间的死亡率无显著差异（RR=0.91，95%CI 0.82-1.02）。累积 SENIORS 试验（心率控制在 68.8 次/分），实验组与对照组之间的死亡率有差异（RR=0.90，95%CI 0.82-0.99）。
β受体阻滞剂治疗心力衰竭的主要作用是通过降低心率来实现。在开始治疗方案前心率为 77 次/分的 HFrEF 患者中，β受体阻滞剂的使用没有获益。在 HFrEF 患者中，β受体阻滞剂的目的是将心率控制在 65-70 次/分。
