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Low heart rate may dampen beta-blocker benefits in patients with heart failure, AF

10 Dec 2019

Low heart rate (HR) in patients with heart failure (HF) and atrial fibrillation (AF) receiving treatment with beta-blockers contributes to an increase in the risk of cardiovascular events, suggesting that a low HR may blunt the beneficial effects of the said drugs, a study has found.

The analysis included 97 HF patients with concomitant AF, grouped according to beta-blocker use (users, n=61; nonusers, n=36) and tertiles of discharge HR (lowest, <60 beats per minute [bpm]; middle, 61–70 bpm; highest, >71 bpm).

The primary endpoint of a composite of rehospitalization due to worsening of HF and all-cause mortality occurred in 37 beta-blocker users (61 percent) and 25 nonusers (69 percent) over a median follow-up of 772 days after discharge.

Multivariable Cox proportional hazard analysis revealed that the risk of the composite outcome was elevated in the lowest HR tertile among beta-blockers users vs the middle (hazard ratio [HR], 2.631, 95 percent confidence interval [CI], 1.078–6.421; p=0.034) and highest tertiles (HR, 2.876, 95 percent CI, 1.147–7.207; p=0.024).

In light of the findings, researchers pointed out that a low HR may lead to bradycardia that can, in turn, worsen HF. This underscores the need to take HR into account during the administration of beta-blockers in HF patients with AF.

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