Benefit of Heart Rate Reduction in Heart Failure

Epidemiological studies have suggested that life expectancy is inversely related to resting heart rate and that the risks of development of heart failure and sudden cardiac death strongly increase with higher resting heart rates [1]. After myocardial infarction, the reduction in mortality with β-blocker treatment was correlated with the extent of heart rate reduction, and in patients with heart failure, a druginduced increase or decrease in heart rate has been associated with an increase or decrease in mortality, respectively [2, 3]. The prognostic relevance of heart rate in patients with coronary artery disease and reduced ejection fraction recently has been demonstrated in the placebo arm of the prospective BEAUTIFUL (morBidity-mortality EvAlUaTion of the If inhibitor ivabradine in patients with coronary disease and left ventricULar dysfunction) study. The BEAUTIFUL study included patients with coronary artery disease and a left ventricular ejection fraction of less than 40%. When patients with heart rates below and above 70 beats per minute were compared, cardiovascular death and heart failure hospitalization were significantly higher in the group of patients with higher heart rates [4].