Heart rate not only predicts outcome but may also be a therapeutic target in patients with chronic heart failure. Several classes of pharmacological agents can be used to modulate heart rate, including beta-blockers, ivabradine, digoxin, amiodarone, and verapamil. Choice of agent will depend on heart rhythm, co-morbidities, and disease phenotype. Beneficial and harmful interactions may also exist. The aim of this paper is to summarize the current body of knowledge regarding the relevance of heart rate as a prognostic factor (risk marker) and particularly as a therapeutic target (risk factor) in patients with chronic heart failure, with a special focus on ivabradine, a novel agent that is currently the only available purely bradycardic agent.
Keywords: Amiodarone; Beta‐blockers; Chronic heart failure; Digoxin; Heart rate; Heart rate‐lowering drugs; Ivabradine; Verapamil.
First published online by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. © The Author 2013.