Characterization of an ambulatory population with stable coronary artery disease and importance of heart rate: the PULSAR registry.

Aims: To characterize a population with stable coronary artery disease (CAD) in an outpatient setting and to evaluate the importance of resting heart rate (HR), a recently recognized prognostic risk factor.

Type Of Study: A prospective and observational registry of patients with stable CAD followed mainly by cardiologists in private outpatient clinics.

Methods: Patients were selected by at least one of the following inclusion criteria: coronary angiography with at least one significant stenosis; positive stress test; previous myocardial infarction; or revascularization by angioplasty or surgery. Demographics, concomitant diseases, HR, blood pressure (BP), presence of angina and medical therapy were all recorded. Data compilation and statistical analysis were performed by a CRO independent of the sponsor and the investigators.

Results: Between May and October 2009, 3477 consecutive patients were included by 186 doctors. Mean age was 66.6 +/- 10.1 years and 26.3% were female, 76% had arterial hypertension, 34% diabetes, 47% previous infarction, 42% angioplasty and 25% coronary surgery. Of concomitant diseases, 13% of patients had peripheral vascular disease or erectile dysfunction. Medical therapy included antiplatelet agents (97%), lipid-lowering agents (92%), beta-blockers (72%), ACEIs (54%), nitrates (39%), calcium blockers (36%), ARBs (28%), ivabradine (24%) and trimetazidine (17%). Mean HR was 67 +/- 12 bpm and 67% of patients had HR > 60 bpm. Mean systolic BP was 134 +/- 18 mmHg and mean diastolic BP was 76 +/- 10 mmHg. Angina was present in 31.3% of patients and 53.4% had class II angina. The population with angina was more severe, 74% had HR > 60 bpm and 68% were taking beta-blockers. In patients with angina and HR > 60 bpm, beta-blocker use was only 64%.

Conclusion: In an outpatient population with stable CAD of whom a third had angina, there was an increased number of patients with HR > 60 bpm and decreased use of beta-blockers with increasing disease severity. These findings support increased use of newly developed drugs for the treatment of stable CAD and angina.