# Hartfrequentie en ritme en het voordeel van bètablokkers bij hartfalen

*geplaatst 2017-06-20 · Hartfalen · Journal of the American College of Cardiology · doi 10.1016/j.jacc.2017.04.001 · https://hartvaat.nl/2017/06/20/hartfrequentie-en-ritme-en-het-voordeel-van-betablokkers-bij-hartfalen/*

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.

## English: Heart Rate and Rhythm and the Benefit of Beta-Blockers in Patients With Heart Failure.

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.

## Abstract (original, from the publication)

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.

Auteurs: 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

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Bron: Journal of the American College of Cardiology, https://doi.org/10.1016/j.jacc.2017.04.001. Bijgewerkt 2026-07-03T18:38:33Z. 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.