Heart rate lowering agents in acute coronary syndrome

Authors

  • Prabhudev R. Banjara Department of Pharmacy Practice, Karnataka College of Pharmacy, Bangalore, Karnataka, India
  • Balakeshwa Ramaiah Department of Pharmacy Practice, Karnataka College of Pharmacy, Bangalore, Karnataka, India
  • Shreya P. Gudur Department of Pharmacy Practice, East West College of Pharmacy, Bangalore, Karnataka, India

DOI:

https://doi.org/10.18203/2319-2003.ijbcp20240987

Keywords:

Acute coronary syndrome, ADR, Beta-blocker, Ivabradine, Negative chronotropic

Abstract

Background: Heart rate is a key indicator of cardiovascular mortality, with ACS having the highest mortality risk when heart rate is elevated. With a target heart rate of <70 bpm, it is crucial to evaluate the effects of medications that lowers heart rate.

Methods: In this prospective observational study, 45 patients with ACS were studied, and it was determined whether or not the patients' heart rates at discharge from the hospital were within goal range. Additionally, we looked at demographics, drug-related issues, vitals and then statistical tests were performed.

Results: The demographic of 45 patients showed mean adult age was 47 years and most observed ACS was STEMI (53.3%). Patients prescribed with HRLA showed lower mean HR, SBP and DBP at discharge. Evaluated Optimal HR ≤70 bpm with HRLA therapy at discharge of the inpatients was achieved in 26.6% (63.5±5.5 bpm).

Conclusions: The current study showed HRLA therapy effectively reduced the heart rate at hospital discharge, but despite being on HRLA only 1/4th of patients achieved the optimal heart rate.

References

Perret-Guillaume C, Joly L, Benetos A. Heart rate as a risk factor for cardiovascular disease. Prog Cardiovasc Dis. 2009;52(1):6-10.

Xu T, Zhan Y, Xiong J, Lu N, He Z, Su X, et al. The relationship between heart rate and mortality of patients with acute coronary syndromes in the coronary intervention era: meta-analysis. Med (United States). 2016;95(46):1-7.

Alapati V, Tang F, Charlap E, Chan PS, Heidenreich PA, Jones PG, et al. Discharge heart rate after hospitalization for myocardial infarction and long-term mortality in 2 US registries. J Am Heart Assoc. 2019;8(3):e010855.

Jabre P, Roger VL, Weston SA, Adnet F, Jiang R, Vivien B, et al. Resting heart rate in first year survivors of myocardial infarction and long-term mortality: A community study. Mayo Clin Proc. 2014;89(12):1655-63.

Cowie MR. Heart rate modulation and exercise capacity. Medicographia. 2012;34(4):387-94.

Antoni ML, Boden H, Delgado V, Boersma E, Fox K, Schalij MJ, et al. Relationship between discharge heart rate and mortality in patients after acute myocardial infarction treated with primary percutaneous coronary intervention. Eur Heart J. 2012;33(1):96-102.

Sidhu NS, Rangaiah SKK, Ramesh D, Veerappa K, Manjunath CN. Clinical characteristics, management strategies, and in-hospital outcomes of acute coronary syndrome in a low socioeconomic status cohort: An observational study from Urban India. Clin Med Insights Cardiol. 2020;14:1179546820918897.

Tickoo S, Bhardwaj A, Fonarow GC, Liang L, Bhatt DL, Cannon CP. Relation between hospital length of stay and quality of care in patients with acute coronary syndromes (from the American Heart Association’s get with the guidelines - coronary artery disease data set). Am J Cardiol. 2016;117(2):201-5.

Gielen S, Backer De G, Wood D. Cardioprotective drugs The ESC Textbook of Preventive Cardiology cardioprotective drugs; 2015:253-4.

Boudonas GE. Β-blockers in coronary artery disease management. Hippokratia. 2010;14(4):231-5.

Stefano De LM. Ferraz ALB, Ferreira AL dos A, Gut AL, Cogni AL, Farah E, et al. Predictors of beta-blocker intolerance and mortality in patients in patients after acute coronary syndrome. PLOS ONE. 2013;8(10):1-6.

Blaufarb I, Pfeifer TM, Frishman WH. β-blockers: drug interactions of clinical significance. Drug Saf. 1995;13(6):359-70.

Uk JM, Uk HD, Poland MT, Kjekshus J, France PL, Denmark CT, et al. Expert consensus document on β-adrenergic receptor blockers: The Task Force on Beta-Blockers of the European Society of Cardiology. Eur Heart J. 2004;25(15):1341-62.

Herman M, Donovan J, Tran M, McKenna B, Gore JM, Goldberg RJ, et al. Use of β-blockers and effects on heart rate and blood pressure post-acute coronary syndromes: Are we on target? Am Heart J. 2009;158(3):378-85.

Irani F, Herial N, Colyer WR. Impact of an acute coronary syndrome pathway in achieving target heart rate and utilization of evidence-based doses of beta-blockers. Am J Ther. 2012;19(6):397-402.

Steg PG, Ferrari R, Ford I, Greenlaw N, Tardif JC, Tendera M, et al. Heart rate and use of beta-blockers in stable outpatients with coronary artery disease. PLOS ONE. 2012;7(5):e36284.

Balode I, Mintāle I, Latkovskis G, Jēgere S, Narbute I, Bajāre I, et al. Insufficient control of heart rate in stable coronary artery disease patients in Latvia. Medicina (Kaunas). 2014;50(5):295-302.

Daly CA, Clemens F, Sendon JL, Tavazzi L, Boersma E, Danchin N, et al. Inadequate control of heart rate in patients with stable angina: Results from the European Heart Survey. Postgrad Med J. 2010;86(1014):212-7.

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Published

2024-04-25

How to Cite

Banjara, P. R., Ramaiah, B., & P. Gudur, S. (2024). Heart rate lowering agents in acute coronary syndrome. International Journal of Basic & Clinical Pharmacology, 13(3), 326–332. https://doi.org/10.18203/2319-2003.ijbcp20240987

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Original Research Articles