How to optimise the treatment of chronic heart failure through pharmacological modulation of the heart rate
Abstract
Resting heart rate (HR) is a significant risk factor of cardiovascular mortality and morbidity in patients with chronic heart failure. Pharmacological slowing of the HR significantly improves prognosis in these patients.
There are several drugs available for slowing the HR. Their role in the treatment of chronic heart failure with reduced ejection fraction is defined by specific quidelines.
Digoxin is used especially for ventricular rate control in patients with heart failure and atrial tachyfibrillation, mostly in combination with a beta-blocker monotherapy is insufficient. The role of digoxin in heart failure and sinus rhythm is very controversial.
Beta-blockers together with ACE (angiotensin converting enzyme) inhibitors are now the drugs of first choice in patients with chronic heart failure. They significantly decrease mortality as well as morbidity.
Their beneficial effect is given mostly by HR slowing. Nevertheless, in some of these patients, the HR remains higher than 70/min despite beta-blocker therapy.
In these patients, it is possible to use a new HR slowing drug, ivabradine, either in combination with a beta-blocker or as monotherapy if the beta-blocker is contraindicated. Additional HR slowing leads to further prowing leads to further prognostic improvement.