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Inadequate control of heart rate in patients with stable angina: results from the European Heart Survey
  1. Caroline A Daly1,
  2. Felicity Clemens2,
  3. Jose L Lopez Sendon3,
  4. Luigi Tavazzi4,
  5. Eric Boersma5,
  6. Nicolas Danchin6,
  7. François Delahaye7,
  8. Anselm Gitt8,
  9. Desmond Julian9,
  10. David Mulcahy10,
  11. Witold Ruzyllo11,
  12. Kristian Thygesen12,
  13. Freek Verheugt13,
  14. Kim M Fox1 on behalf of the Euro Heart Survey Investigators
  1. 1Royal Brompton Hospital, London, UK
  2. 2London School of Hygiene and Tropical Medicine, London, UK
  3. 3Hospital Universitario Gregorio Maranon, Madrid, Spain
  4. 4Policlinico S. Matteo, Pavia, Italy
  5. 5Clinical Epidemiology Unit, Erasmus MC, Rotterdam, The Netherlands
  6. 6Hopital Europeen Georges Pompidou, Paris, France
  7. 7Hopital Cardiovasculaire et Pneumologique Louis Pradel, Lyons, France
  8. 8Herzzentrum Luwigshafen, Ludwigshafen, Germany
  9. 9University of Newcastle upon Tyne, Newcastle upon Tyne, UK
  10. 10Adelaide And Meath incorporating National Children's Hospital, Dublin, Ireland
  11. 11Institute of Cardiology, Warsaw, Poland
  12. 12Aarhus University Hospital, Denmark
  13. 13University Medical Centre St Radboud, Nijmegen, The Netherlands
  1. Correspondence to Caroline Daly, St James's Hospital, Dublin 8, Ireland; cadaly{at}stjames.ie

Abstract

Aims 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.

Methods and results 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, β-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.

Conclusion 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.

  • Adult cardiology
  • ischaemic heart disease

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Footnotes

  • Funding The Euro Heart Survey of Angina received support from the Servier Foundation.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Local institutional ethics for participating centres.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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