{"id":"7aa5ea3266d0","type":"article","url":"https://hartvaat.nl/2017/06/20/hartfrequentie-en-ritme-en-het-voordeel-van-betablokkers-bij-hartfalen/","title":"Hartfrequentie en ritme en het voordeel van bètablokkers bij hartfalen","title_en":"Heart Rate and Rhythm and the Benefit of Beta-Blockers in Patients With Heart Failure.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen","bisoprolol","carvedilol","hfref","ivabradine"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2017.04.001","source_url":"https://doi.org/10.1016/j.jacc.2017.04.001","authors":["Dipak Kotecha","Marcus D Flather","Douglas G Altman","Jane Holmes","Giuseppe Rosano","John Wikstrand","Milton Packer","Andrew J S Coats","Luis Manzano","Michael Böhm","Dirk J van Veldhuisen","Bert Andersson","Hans Wedel","Thomas G von Lueder","Alan S Rigby","Åke Hjalmarson","John Kjekshus","John G F Cleland"],"significance":7,"published":"2017-06-20","source_date":"2017-06-20","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/betablokkers-cardiale-indicaties/","https://hartvaat.nl/kennis/hartfalen/hfref-hartfalen-met-verminderde-ejectie/"],"congress":"","summary_en":"This analysis examined the interaction between heart rate, rhythm (sinus rhythm vs AF), and beta-blocker benefit in heart failure, providing insights into which patients derive the most benefit from heart rate lowering.","created":"2026-07-03T10:26:45Z","updated":"2026-07-03T18:38:33Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse naar de interactie tussen hartfrequentie, hartritme (sinusritme vs AF) en het behandelvoordeel van bètablokkers bij hartfalen. Relevant voor de therapiekeuze bij HF met AF.","abstract_original":"BACKGROUND: The relationship between mortality and heart rate remains unclear for patients with heart failure with reduced ejection fraction in either sinus rhythm or atrial fibrillation (AF). OBJECTIVES: This analysis explored the prognostic importance of heart rate in patients with heart failure with reduced ejection fraction in randomized controlled trials comparing beta-blockers and placebo. METHODS: The Beta-Blockers in Heart Failure Collaborative Group performed a meta-analysis of harmonized individual patient data from 11 double-blind randomized controlled trials. The primary outcome was all-cause mortality, analyzed with Cox proportional hazard ratios (HR) modeling heart rate measured at baseline and approximately 6 months post-randomization. RESULTS: A higher heart rate at baseline was associated with greater all-cause mortality for patients in sinus rhythm (n = 14,166; adjusted HR: 1.11 per 10 beats/min; 95% confidence interval [CI]: 1.07 to 1.15; p < 0.0001) but not in AF (n = 3,034; HR: 1.03 per 10 beats/min; 95% CI: 0.97 to 1.08; p = 0.38). Beta-blockers reduced ventricular rate by 12 beats/min in both sinus rhythm and AF. Mortality was lower for patients in sinus rhythm randomized to beta-blockers (HR: 0.73 vs. placebo; 95% CI: 0.67 to 0.79; p < 0.001), regardless of baseline heart rate (interaction p = 0.35). Beta-blockers had no effect on mortality in patients with AF (HR: 0.96, 95% CI: 0.81 to 1.12; p = 0.58) at any heart rate (interaction p = 0.48). A lower achieved resting heart rate, irrespective of treatment, was associated with better prognosis only for patients in sinus rhythm (HR: 1.16 per 10 beats/min increase, 95% CI: 1.11 to 1.22; p < 0.0001). CONCLUSIONS: Regardless of pre-treatment heart rate, beta-blockers reduce mortality in patients with heart failure with reduced ejection fraction in sinus rhythm. Achieving a lower heart rate is associated with better prognosis, but only for those in sinus rhythm."}