Target Pulse Rate for Patients with Heart Failure

Heart Rate Targets

The American College of Cardiology recommends a target resting heart rate of <70 beats/min for heart failure patients in sinus rhythm on beta-blocker therapy, with achieving the target beta-blocker dose being the primary goal regardless of the achieved heart rate 1
For patients with atrial fibrillation and heart failure, a target heart rate of 60-100 beats/min at rest is recommended, with one study suggesting up to 110 beats/min may be acceptable 1
The American College of Cardiology also suggests that a target rate of <80 beats/min at rest and <110 beats/min during a 6-minute walk test may be appropriate for patients with atrial fibrillation and heart failure 2, 3

The European Society of Cardiology recommends starting with a low-dose evidence-based beta-blocker (carvedilol, metoprolol succinate, or bisoprolol) and uptitrating every 1-2 weeks using small increments until target dose is achieved, with a goal of reaching target doses used in clinical trials: carvedilol 25-50 mg twice daily, metoprolol succinate 200 mg daily, or bisoprolol 10 mg daily 4
The American College of Cardiology recommends that if heart rate ≥70 beats/min in sinus rhythm despite maximally tolerated beta-blocker, consider adding ivabradine (starting dose 2.5-5 mg twice daily) 5

The American College of Cardiology recommends that beta-blockers remain first-line for rate control in HFrEF with AF, reducing mortality and hospitalizations beyond just rate control effects 2, 3
The European Heart Journal suggests that achieving strict rate control (<60 beats/min) may be harmful in patients with AF and HFrEF, and lenient control (60-100 beats/min) is preferred 1, 6

The American College of Cardiology recommends avoiding combining verapamil or diltiazem with beta-blockers in AF, as this combination is contraindicated 1