Heart rate: a prognostic factor and therapeutic target in chronic heart failure. The distinct roles of drugs with heart rate-lowering properties

Eur J Heart Fail. 2014 Jan;16(1):76-85. doi: 10.1093/eurjhf/hft129. Epub 2013 Dec 3.


Heart rate not only predicts outcome but may also be a therapeutic target in patients with chronic heart failure. Several classes of pharmacological agents can be used to modulate heart rate, including beta-blockers, ivabradine, digoxin, amiodarone, and verapamil. Choice of agent will depend on heart rhythm, co-morbidities, and disease phenotype. Beneficial and harmful interactions may also exist. The aim of this paper is to summarize the current body of knowledge regarding the relevance of heart rate as a prognostic factor (risk marker) and particularly as a therapeutic target (risk factor) in patients with chronic heart failure, with a special focus on ivabradine, a novel agent that is currently the only available purely bradycardic agent.

Keywords: Amiodarone; Beta‐blockers; Chronic heart failure; Digoxin; Heart rate; Heart rate‐lowering drugs; Ivabradine; Verapamil.

Publication types

  • Review

MeSH terms

  • Adrenergic beta-Antagonists / therapeutic use*
  • Heart Failure / drug therapy*
  • Heart Failure / physiopathology
  • Heart Rate / drug effects
  • Heart Rate / physiology*
  • Humans
  • Prognosis


  • Adrenergic beta-Antagonists