Heart Rate in Patients with Coronary Artery Disease in Latvia. Summary of the Doctoral Thesis

Abstract

Increased resting heart rate (HR) is independent cardiovascular (CV) risk factor included in European and Latvian Guidelines on CV prevention. HR ≥ 70 beats per minute (bpm) increases CV risk in coronary artery disease (CAD) patients. However, importance of HR as a risk factor is underestimated in Latvia and there is lack of data regarding HR and its control in patients with CAD in Latvia. The aim of study was to analyze different aspects related to HR and its control in treated outpatients with stable CAD as well as to verify possible reasons for insufficient HR control. Sample of treated outpatients with stable CAD was created during the study and HR, other risk factors, symptoms as well as treatment were analyzed. Changes over time were assessed by following–up the same patients during three year period as well as comparing of created sample with another population of stable CAD patients already analyzed several years before. Doses and combinations of HR reducing agents used as well as changes in treatment habits over time were assessed. Comparison of CAD patients with general population also was done as well as assessment of practitioners’ viewpoint regarding HR. Results of study disclose insufficient HR control in treated outpatients with CAD. Despite wide use of β blockers substantial part of patients (more than one third) has increased HR ≥ 70 bpm. Comparison of CAD patients with general Latvian population elucidates better control of several important risk factors including HR in CAD patients, but follow–up of patients over three year period unfortunately does not show improvement in HR management while control of other risk factors like hypertension, dyslipidemia and smoking is improved. Study indicates underdose of β blockers and rare combination of those agents with ivabradine as possible reasons for insufficient HR control. Discovered by questionnaire lack of the common practitioners’ view regarding level of HR, which should be considered as normal or high in CAD patients may also play a role in insufficient HR control. Study adds knowledge about HR control in CAD patients in Latvia and elucidates potential for targeting this risk factor. Better HR control in future could be step forward further improvement of prognosis in CAD patients in Latvia.