Introduction:
Higher heart rates (HR) are associated with worse outcomes in heart failure (HF) patients. HR management for this population is recommended in ESC 2021 guidelines and is even more important in the patients with multiple HF hospital admissions, a high-risk population. Determining whether guideline directed medical therapy (GDMT), using Ivabradine and beta-blockers, results in HR control in HF patients is an area of active research. The purpose of this analysis is to determine whether the use of GDMT along with weekly follow-up in patients with recurrent HF can lead to improved HR control.Methods: In the study Benefits of Microcor in Ambulatory Decompensated Heart Failure (BMAD HF, NCT03476187) a patch-based monitoring device, HFMS (µCor Heart Failure Management System, ZOLL, Pittsburgh, USA), made HR measurements every minute. In this sub-study, we included those BMAD HF subjects who met the following criteria: 1)
≥ 30 days between beginning and end of HFMS use and 2) HFMS nighttime heart rate (NHR) data available for ≥ 2 hours at the beginning-of-use (BOU) and ≥ 2 hours at the end-of-use (EOU). All the subjects had been hospitalized for HF at least twice within the prior 6 months and enrolled in the study within 10 days of their latest hospitalization. Subjects were contacted weekly and had in-person or virtual visits with their physician monthly. At the contact timepoints, the physicians adjusted medical therapy per routine practice while blinded to the HR data. In this analysis, median NHR at BOU (7 days) was compared to the median NHR at EOU (7 days) for all subjects combined, and for subgroups of HFrEF (≤ 40%) and HFpEF (> 40%).Results: 115 subjects wore the device for an average of 69 days (range: 12-175). As shown in Figure 1, 14% of subjects with an initially high NHR improved from BOU to EOU. However, 28% of subjects initially discharged with a controlled NHR had an increase in NHR to > 70 bpm. Overall, at EOU the number of subjects without NHR control actually increased (50% at BOU and 57% at EOU). Comparing the NHR in HFrEF group with the HFpEF group, the HFrEF group had higher NHR at both BOU (p = 0.02) and EOU (p = 0.003).
Discussion: We found that 50% of patients discharged after an acute HF event did not meet GDMT heart rate control at the time of discharge. This percentage declined over time, more notably in patients with HFrEF. Weekly follow-up and monthly doctor visit did not improve NHR management. Further studies are required to determine whether unblinding the physicians to HR data and/or using an alert mechanism would help to improve NHR management.
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