Heart rate control in chronic systolic heart failure patients in Germany: results of a nationwide survey

Introduction: Results of epidemiological surveys (eg, Euro Heart Survey) point to inadequate guideline-oriented pharmacological treatment of patients with chronic systolic heart failure (HF), including insufficient control of heart rate. Increased resting heart rate is associated with increased morbidity and mortality in these patients. Methods: In order to analyze the current pharmacomedical health care utilization of patients suffering from chronic systolic HF, we conducted a prospective multicenter screening (INDICATE: ScreenINg of toDay's patIents with Chronic systolic heArT failurE). Data were collected from February to June 2012 by 793 specialists throughout Germany. Descriptive statistics was applied for data analysis. Results: Overall, data from 15 148 outpatients with chronic systolic HF were analyzed: mean age 70±11 years, 63% male, 37% female, 87% in NYHA class II or III and 67% in sinus rhythm. In 88% of all patients the diagnosis had been known for more than 6 months, so the uptitration phase could be considered finished. Despite current beta-blocker therapy (86% of the population), the resting heart rate was frequently inadequately controlled (mean heart rate 73 bpm). 42% of the population presented with a heart rate of ≥75 bpm. Increased heart rate was documented irrespective of the achieved mean or maximally tolerated beta-blocker dose: 34% of the population with <50% of target dose and mean heart rate 72±13 bpm, 49% with 50 - <100% of target dose and mean heart rate 73±13 bpm and 17% with ≥100% of the target dose and mean heart rate 74±13 bpm. Conclusion: This large nationwide cross-sectional screening program in outpatients with chronic systolic HF in Germany demonstrated that a significant proportion of this population still presents with an increased heart rate (ie, ≥75 bpm) irrespective of current beta-blocker treatment. INDICATE underscores the currently unmet medical need for guideline-oriented pharmacological optimization of resting heart rate in chronic systolic HF.