Inadequate heart rate control despite widespread use of beta-blockers in outpatients with stable CAD: findings from the international prospective CLARIFY registry.

Abstract

BACKGROUND:

To use CLARIFY, a prospective registry of patients with stable CAD (45 countries), to explore heart rate (HR) control and beta-blocker use.

METHODS:

We analyzed the CLARIFY population according to beta-blocker use via descriptive statistics with Pearson's χ(2) test for comparisons, as well as a multivariable stepwise model.

RESULTS:

Data on beta-blocker use was available for 32,914 patients, in whom HR was 68 ± 11 bpm; patients with angina, previous myocardial infarction, and heart failure had HRs of 69 ± 12, 68 ± 11, and 70 ± 12 bpm, respectively. 75% of these patients were receiving beta-blockers. Bisoprolol (34%), metoprolol tartrate (16%) or succinate (13%), atenolol (15%), and carvedilol (12%) were mostly used; mean dosages were 49%, 76%, 35%, 53%, and 45% of maximum doses, respectively. Patients aged <65 years were more likely to receive beta-blockers than patients ≥ 75 years (P<0.0001). Gender had no effect. Subjects with HR ≤ 60 bpm were more likely to be on beta-blockers than patients with HR ≥ 70 bpm (P<0.0001). Patients with angina, previous myocardial infarction, heart failure, and hypertension were more frequently receiving beta-blockers (all P<0.0001), and those with PAD and asthma/COPD less frequently (both P<0.0001). Beta-blocker use varied according to geographical region (from 87% to 67%).

CONCLUSIONS:

Three-quarters of patients with stable CAD receive beta-blockers. Even so, HR is insufficiently controlled in many patients, despite recent guidelines for the management of CAD. There is still much room for improvement in HR control in the management of stable CAD.

• Authors: Michal Tendera, Kim Fox, Roberto Ferrari, Ian Ford, Nicola Greenlaw, Hélène Abergel, Cezar Macarie, Jean-Claude Tardif, Panos Vardas, José Zamorano, P Gabriel Steg, CLARIFY Registry Investigators
• Journal: International journal of cardiology (Int J Cardiol) Vol. 176 Issue 1 Pg. 119-24 (Sep 2014) ISSN: 1874-1754 [Electronic] Netherlands
• PMID: 25042656 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Chemical References

• Adrenergic beta-Antagonists

Topics

• Adrenergic beta-Antagonists (pharmacology, therapeutic use)
• Adult
• Aged
• Aged, 80 and over
• Ambulatory Care (methods, trends)
• Cohort Studies
• Coronary Artery Disease (drug therapy, physiopathology)
• Female
• Follow-Up Studies
• Heart Rate (drug effects)
• Humans
• Internationality
• Male
• Middle Aged
• Prospective Studies
• Registries