Average Resting Heart Rate in Indian Patients with Heart Failure with Reduced Ejection Fraction: Results from the Real-World Milestone Registry

IntroductionThis study aimed to describe the resting heart rate (RHR), blood pressure (BP), and prescription patterns of heart rate (HR)-lowering medications in Indian patients with stable heart failure with reduced ejection fraction (HFrEF) in routine outpatient practice. MethodsThis observational study enrolled adults (New York Heart Association (NYHA) classes II-III) receiving outpatient care at 15 Indian centers.RHR, BP, and prescribed HR-lowering medications were recorded at baseline and three months. ResultsOf 295 patients, 249 completed follow-up; 78.6% were male, and ischemic etiology predominated (76.2%).Comorbidities included diabetes (54.9%), hypertension (52.8%), dyslipidemia (44.0%), chronic kidney disease (12.2%), and obesity (7.4%).Mean RHR declined by 6.9 bpm (from 79.2 ± 14.9 to 72.6 ± 11.1 bpm; paired mean change -6.9 ± 11.3 bpm, p < 0.001), with stable BP.Beta-blockers (mainly bisoprolol) were used in 82.0% of patients, although target doses were infrequently achieved.Ivabradine (mostly 5 mg twice daily) was prescribed in 45% of patients.Combination therapy was associated with the greatest observed HR reduction.N-terminal pro-B-type natriuretic peptide levels, available in a subset of patients, also decreased over the study period.No adverse reactions were reported. ConclusionPatients with HFrEF showed a high comorbidity burden but a low prevalence of obesity.Beta-blockers remained the predominant therapy, while combination therapy with beta-blockers and ivabradine was associated with the greatest observed HR reduction.Given the observational, nonrandomized design, these findings are descriptive and hypothesis-generating.