β-Blockade in Heart Failure With Reduced Ejection Fraction: Does Heart Rate Control Influence Readmissions?

Abstract

Background: Raised resting heart rate (HR), >70 beats per minute (bpm), has been shown to be a risk factor for adverse cardiovascular outcomes and hospital readmissions, specifically in patients with heart failure with reduced ejection fraction (HFrEF). Given their mortality benefit, β-blockers are recommended in HFrEF, with a goal to titrate to a maximum tolerated dose rather than a specific HR target. Objective: To determine the impact of optimal HR control achievement prior to hospital discharge on hospital readmissions in patients with HFrEF receiving β-blockade. Methods: A retrospective study of patients admitted to 5 adult hospitals within a large urban health-care system, between 2013 and 2015, was conducted. Patients were identified via International Classification of Diseases, Ninth Revision (ICD-9) coding for acute on chronic HFrEF. Results: Of the 225 patients included, 20% achieved optimal HR control (n = 46, HR <70 bpm; n = 179, HR ≥70 bpm) and only 15% received β-blocker titration during hospital admission. Of note, 25% of patients receiving ≥50% target dose (n = 79) and 28% receiving 100% target dose (n = 39) achieved optimal HR control. At 30 days, patients with an HR <70 bpm versus HR ≥70 bpm exhibited similar readmission rates (9% vs 11%, respectively; P > .99) and ED visits (11% vs 8%, respectively; P = .57). Conclusions: Readmission rates were similar among patients with HFrEF despite the majority failing to achieve optimal HR control from β-blockade. However, β-blocker dosing remains suboptimal relative to guideline-recommended target doses. Opportunities exist for inpatient clinicians to optimize β-blockade in an attempt to achieve HR control.