DOI: http://dx.doi.org/10.18203/2349-3933.ijam20214147

Elevated heart rate across cardiovascular continuum and its management

Ashok Punjabi, Sheeba George, Peyush Khera, Sameer Srivastava

Abstract


Elevated heart rate in both healthy individuals and patients with coronary artery disease (CAD), acute myocardial infarction (AMI) and heart failure poses a major risk factor for morbidity and mortality. This fact has further been supported by several studies pointing out to elevated resting heart rate as an important marker for this catastrophe necessitating a prompt therapeutic action plan, consisting of early detection and treatment of the risk factors, to achieve ideal heart rates (approximately 60 beats/minute) in patients which could stop or prevent the progression of the cardiovascular disease (CVD) continuum. Lowering heart rate by therapeutic interventions has shown favorable results, but most of the data so far is retrospective and limited to AMI and heart failure with beta-blocker treatment. Addition of newer drugs into the cardiac armamentarium, like ivabradine, a sinus node inhibitor acting by selective heart rate reduction, has shown several beneficial effects in a variety of conditions spanning from stable angina to heart failure. A consensus meeting was held at the national level wherein experts from various parts of the country discussed and reviewed the importance of heart rate lowering across CV continuum and addition of ivabradine for patients with chronic heart failure and chronic stable angina.


Keywords


Cardiovascular disease, Acute myocardial infarction, Chronic stable angina, Heart failure, Ivabradine

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References


Ferrari R. Heart rate in the management of cardiovascular patients: it’s time to act. Medicographia. 2012;34:379-86.

Levine HJ. Rest heart rate and life expectancy. J Am Coll Cardiol. 1997;30:1104-6.

Custodis F, Reil JC, Laufs U, Böhm M. Heart rate: A global target for cardiovascular disease and therapy along the cardiovascular disease continuum. J Cardiol. 2013;62:183-7.

Boudoulas KD, Borer JS, Boudoulas H. Heart rate, life expectancy and the cardiovascular system: Therapeutic considerations. Cardiology. 2015;132:199-212.

Singh BN. Increased heart rate as a risk factor for cardiovascular disease. Eur Heart J Suppl. 2003;5:3-9.

Palatini P, Benetos A, Grassi G, Julius S, Kjeldsen SE, Mancia G, et al. Identification and management of the hypertensive patient with elevated heart rate: statement of a European Society of Hypertension Consensus Meeting. J Hypertens. 2006;24:603-10.

Cooney MT, Vartiainen E, Laatikainen T, Juolevi A, Dudina A, Graham IM. Elevated resting heart rate is an independent risk factor for cardiovascular disease in healthy men and women. Am Heart J. 2010;159:612-9.

Pfister R, Michels G, Sharp SJ, Luben R, Wareham NJ, Khaw KT. Resting heart rate and incident heart failure in apparently healthy men and women in the EPIC-Norfolk study. Eur J Heart Fail. 2012;14:1163-70.

Gillman MW, Kannel WB, Belanger A, D'Agostino RB. Influence of heart rate on mortality among persons with hypertension: the Framingham Study. Am Heart J. 1993;125:1148-54.

Benetos A, Rudnichi A, Thomas F, Safar M, Guize L. Influence of heart rate on mortality in a French population: role of age, gender, and blood pressure. Hypertension. 1999;33:44-52.

Farinaro E, Stranges S, Guglielmucci G, Iermano P, Celentano E, Cajafa A, et al. Heart rate as a risk factor in hypertensive individuals. The Italian Tensio Pulse Study. Nutr Metab Cardiovasc Dis. 1999;9:196-202.

Thomas F, Rudnichi A, Bacri AM, Bean K, Guize L, Benetos A. Cardiovascular mortality in hypertensive men according to presence of associated risk factors. Hypertension. 2001;37:1256-61.

Palatini P, Thijs L, Staessen JA, Fagard RH, Bulpitt CJ, Clement DL, et al. Predictive value of clinic and ambulatory heart rate for mortality in elderly subjects with systolic hypertension. Arch Intern Med. 2002;162:2313-21.

Okin PM, Kjeldsen SE, Julius S, Hille DA, Dahlöf B, Edelman JM, et al. All-cause and cardiovascular mortality in relation to changing heart rate during treatment of hypertensive patients with electrocardiographic left ventricular hypertrophy. Eur Heart J. 2010;31:2271-9.

Gordon R, Gwathmey JK, Xie L. Autonomic and endocrine control of cardiovascular function. World J Cardiol. 2015;7:204-14.

Arnold JM, Fitchett DH, Howlett JG, et al. Resting heart rate: A modifiable prognostic indicator of cardiovascular risk and outcomes? Can J Cardiol. 2008;24:3-8.

Zamorano JL. Heart rate management: a therapeutic goal throughout the cardiovascular continuum. Eur Heart J. 2008;10:17-21.

Reule S, Drawz PE. Heart rate and blood pressure: Any possible implications for management of hypertension? Curr Hypertens Rep. 2012;14:478-84.

Hjalmarson A. Heart rate: an independent risk factor in cardiovascular disease. Eur Heart J. 2007;9:3-7.

Raja DC, Kapoor A, Sinha A, Kashyap S, Khanna R, Kumar S, et al. Heart rate manipulation in dilated cardiomyopathy: assessing the role of ivabradine. Indian Heart J. 2018;70:246-51.

Böhm M, Reil JC, Deedwania P, Kim JB, Borer JS. Resting heart rate: risk indicator and emerging risk factor in cardiovascular disease. Am J Med. 2015;128:219-28.

Palatini P. Recommendations on how to measure resting heart rate. Medicographia. 2009;31:414-9.

Kobayashi H. Effect of measurement duration on accuracy of pulse counting. Ergonomics. 2013;56:1940-4.

Hill RD, Smith RB. Examination of the extremities: pulses, bruits, and phlebitis. Walker HK, Hall WD, Hurst JW, Editors. Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition. Boston: Butterworths. 1990;30.

Opdahl A, Venkatesh BA, Fernandes VRS, Wu CO, Nasir K, Choi EY, et al. Resting heart rate as predictor for left ventricular dysfunction and heart failure: The multi-ethnic study of atherosclerosis. J Am Coll Cardiol. 2014;63:1182-9.

Hori M, Okamoto H. Heart rate as a target of treatment of chronic heart failure. J Cardiol. 2012;60:86-90.

Zhang D, Shen X, Qi X. Resting heart rate and all-cause and cardiovascular mortality in the general population: a meta-analysis. CMAJ. 2016;188:53-63.

Custodis F, Baumhäkel M, Schlimmer N, List F, Gensch C, Böhm M, et al. Heart rate reduction by ivabradine reduces oxidative stress, improves endothelial function, and prevents atherosclerosis in apolipoprotein E-deficient mice. Circulation. 2008;117:2377-87.

Drouin A, Gendron ME, Thorin E, Gillis MA, Mahlberg-Gaudin F, Tardif JC, et al. Chronic heart rate reduction by ivabradine prevents endothelial dysfunction in dyslipidaemic mice. Br J Pharmacol. 2008;154:749-57.

Baumhäkel M, Custodis F, Schlimmer N, Laufs U, Böhm M. Heart rate reduction with ivabradine improves erectile dysfunction in parallel to decrease in atherosclerotic plaque load in ApoE-knockout mice. Atherosclerosis. 2010;212:55-62.

Albaladejo P, Carusi A, Apartian A, Lacolley P, Safar ME, Bénétos A. Effect of chronic heart rate reduction with ivabradine on carotid and aortic structure and function in normotensive and hypertensive rats. J Vasc Res. 2003;40:320-8.

Beere PA, Glagov S, Zarins CK. Retarding effect of lowered heart rate on coronary atherosclerosis. Science. 1984;226:180-2.

Beere PA, Glagov S, Zarins CK. Experimental atherosclerosis at the carotid bifurcation of the cynomolgus monkey. Localization, compensatory enlargement, and the sparing effect of lowered heart rate. Arterioscler Thromb. 1992;12:1245-53.

Zheng W, Brown MD, Brock TA, Bjercke RJ, Tomanek RJ. Bradycardia-induced coronary angiogenesis is dependent on vascular endothelial growth factor. Circ Res. 1999;85:192-8.

Li J, Hampton T, Morgan JP, Simons M. Stretch-induced VEGF expression in the heart. J Clin Invest. 1997;100:18-24.

Heusch G, Skyschally A, Gres P, van Caster P, Schilawa D, Schulz R. Improvement of regional myocardial blood flow and function and reduction of infarct size with ivabradine: protection beyond heart rate reduction. Eur Heart J. 2008;29:2265-75.

Tardif JC, Ford I, Tendera M, Bourassa MG, Fox K. Efficacy of ivabradine, a new selective I(f) inhibitor, compared with atenolol in patients with chronic stable angina. Eur Heart J. 2005;26:2529-36.

Borer JS, Fox K, Jaillon P, Lerebours G. Antianginal and antiischemic effects of ivabradine, an I(f) inhibitor, in stable angina: a randomized, double-blind, multicentered, placebo-controlled trial. Circulation. 2003;107:817-23.

Westenbrink BD, van Gilst WH. Why should we consider heart rate in patients with cardiovascular disease? Medicographia. 2012;34:421-5.

Daly C. Is heart rate optimally controlled in patients with coronary artery disease in clinical practice? Medicographia. 2009;31:364-70.

Weber MA. The role of the new-blockers in treating cardiovascular disease. Am J Hypertens. 2005;18:169-76.

Farzam K, Jan A. Available at: https://www.ncbi.nlm.nih.gov/books/NBK532906/. Accessed on 05 May 2021.

Ong HT. β blockers in hypertension and cardiovascular disease. BMJ. 2007;334:946-9.

de Groote P, Isnard R, Assyag P, Clerson P, Ducardonnet A, Galinier M, et al. Is the gap between guidelines and clinical practice in heart failure treatment being filled? Insights from the IMPACT RECO survey. Eur J Heart Fail. 2007;9:1205-11.

Fonarow GC, Abraham WT, Albert NM, Stough WG, Gheorghiade M, Greenberg BH, et al. Dosing of beta-blocker therapy before, during, and after hospitalization for heart failure (from Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure). Am J Cardiol. 2008;102:1524-9.

Richards TR, Tobe SW. Combining other antihypertensive drugs with β-blockers in hypertension: a focus on safety and tolerability. Can J Cardiol. 2014;30:42-6.

Hidalgo FJ, Carrasco F, Castillo JC, Rodríguez S, Pardo L, Durán E, et al. Early therapy with beta blockers plus ivabradine versus beta blockers alone in patients hospitalised with heart failure and reduced ejection fraction (ETHIC-AHF Study): Results at one-year follow-up. Int J Clin Cardiol. 2017;4:093.

Arden C. Available at: https://www.guidelinesinpractice.co.uk/cardiovascular/controlling-heart-rate-is-key-when-managing-stable-angina/311313.article. Accessed on 05 May 2021.

KösterR, Kaehler J, Meinertz T. Treatment of stable angina pectoris by ivabradine in every day practice: the REDUCTION study. Am Heart J. 2009;158:51-7.

Ferrari R. Ivabradine in the management of coronary artery disease with or without left ventricular dysfunction or heart failure. Eur Heart J. 2015;17:24-9.

Kaski JC, Gloekler S, Ferrari R, Fox K, Levy BI, Komajda M, et al. Role of ivabradine in management of stable angina in patients with different clinical profiles. Open Heart. 2018;5:e000725.