Insufficient control of heart rate in stable coronary artery disease patients in Latvia

Background and objective: Heart rate (HR) ≥70 beats per minute (bpm) increases cardiovascular risk in coronary artery disease (CAD) patients. The objective of the analysis is to characterize HR as well as other clinical parameters in outpatients with stable CAD in Latvia. Materials and methods: CLARIFY is an ongoing international registry of outpatients with established CAD. Latvian data regarding 120 patients enrolled in CLARIFY and collected at baseline visit during 2009–2010 were analyzed. Results: The mean HR was 67.7 ± 9.5 and 66.9 ± 10.7 bpm when measured by pulse palpation and electrocardiography, respectively. HR ≤60 bpm and ≥70 bpm was observed in 25% and 35.8% of patients, respectively. When analyzing patients with angina symptoms, 22.8% had HR ≤60 bpm while HR ≥70 bpm was observed in 33.3% of the cases. HR ≥70 bpm was observed in 36.2% of patients with symptoms of chronic heart failure. Beta-blockers were used in 81.7% of the patients. Metoprolol (long acting succinate), bisoprolol, nebivolol and carvedilol in average daily doses 63.8, 5.3, 4.5, and 10.4 mg/d were used in 47, 37, 11 and 3 cases, respectively. Among patients with HR ≥70 bpm 79.1% were using beta-blockers. Medications did not differ significantly between the three groups according to HR level (≤60, 61–69 and ≥70 bpm). Conclusions: Despite the wide use of beta-blockers, HR is insufficiently controlled in the analyzed sample of stable CAD patients in Latvia. Target HR ≤60 bpm is achieved only in 25% of the patients while more than one third have increased HR ≥70 bpm