POSSIBILITY OF ACHIEVING STRICT CONTROL HEART RATE IN PATIENTS WITH PERMANENT ATRIAL FIBRILLATION NON-VALVULAR ETIOLOGY AND HEART FAILURE
DOI:
https://doi.org/10.11603/1811-2471.2018.v0.i4.9744Keywords:
heart rate, atrial fibrillation, heart failure, beta-blockers, controlAbstract
The aim of the study – to determine the predictors of the achievement of strict control of heart rate in patients with PFTF and concomitant heart failure at the time of discharge from the hospital, to identify the benefits of using bisoprolol or carvedilol for monitoring heart rate.
Material and Methods. The study consistently included 30 patients. The observation duration was (238.3±17.0) days, the design provided for 3 visits. Titration of the dose of BB was carried out (67.7±10.3) days (interval between 1 and 2 visits). Reception of the maximum or maximum tolerated dose of BB lasted (170.6±17.7) days (interval between 2 and 3 visits). Paired exercise tests — a treadmill test (TT) and a 6-minute walk test (6MWT) were performed during 2 and 3 visits.
Results and Discussion. Patients were divided into two groups – HFpEF (n=159) and HFrEF (n=64) LV according to echocardiography and subgroups according to the assigned BB. The average heart rate for ECG at the time of discharge from the hospital was (78.6±11.1) beats / min, in 148 (66.4 %) patients had severe heart rate control, and in 75 (33.6 %) was mild. For the control of heart rate, the following drugs were used: bisoprolol in 171 (76.7 %) patients, carvedilol in 52 (23.3 %), digoxin in 81 (36.3 %). A high dose of β-adrenoblockers, that is, a mediator and higher, occurred in 139 (81.3 %) cases with bisoprolol and in 24 (46.2 %) when receiving carvedilol. At the time of discharge, the dosage for the control of heart rate was as follows: bisoprolol – (6.3±3) mg, carvedilol – (23.7±15.8) mg, digoxin – (0.21±0.10) mg.
Conclusions. At the time of the issue of strict control of heart rate in patients with PAF reached 34.4 % and concomitant HFrEF and 63.5 % and concomitant HFpEF, and soft heart rate control – in 65.6 % and 36.5 % of patients, respectively. Possibility of achieving tight control of heart rate at the time of discharge in patients with PAF and concomitant HF also decreases when using carvedilol compared to bisoprolol (p=0.049) when standardized for other risk factors. At the same time, as a consequence, the use of digoxin (p=0.03), as an auxiliary preparation for control of heart rate increases. The possibility of achieving tight control of heart rate at the time of discharge of patients with PAF and concomitant HF is associated with the use of high doses (mean therapeutic and higher) β-blockers (p<0.001), and, when standardized by other risk factors, the use of bisoprolol does not have a significant benefit compared with carvedilol therapy (p=0.57), but there is a dose-dependent effect (p=0.02).
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