Discharge heart rate and future events among Japanese patients with acute heart failure receiving beta-blocker therapy

Background: Randomized trials have demonstrated the efficacy of beta-blockers (BBs) in heart failure (HF) patients. We sought to assess the impact of BBs on long-term outcome; in particular, we assessed the association between outcome and BB dose and discharge heart rate. Methods and Results: Prescriptions for dispensed medication and outcomes were identified from a prospective, single-institution HF registry. Long-term prognosis was compared between users and non-users of BBs. BB users were further divided into 2 groups based on dose (full and non-full dose) and discharge heart rate (<70 bpm and ≥70 bpm). The primary endpoint was defined as either death or hospitalization due to HF. Of 199 patients, 158 (79.4%) were receiving BBs at discharge. Their mean age was 66.8 ± 15.84 years. Compared with non-users of BBs, BB users were younger (65.0 ± 15.5 vs 73.8 ± 13.3 years, P = 0.001) and had a lower ejection fraction (36.0% ± 14.0% vs 48.3% ± 11.7%, p < 0.001). The use of BBs had no effect on long-term outcome (HR = 2.564, P = 0.246), whereas the eventfree rate was significantly decreased with increasing heart rate (stratified by 70 bpm; log-rank P = 0.05). A discharge heart rate of >70 bpm was significantly associated with impaired long-term outcome (HR = 1.872, P = 0.04). Conclusions: Optimizing heart rate, rather than maximizing BB dose, appears to be an appropriate treatment strategy for the beta-sensitive Japanese population.