Physiology and medical technology meet personalised medicine: Extending the indication for optimised heart rate management

Background:The cardinal symptom of heart failure (HF), exercise intolerance, persists across all degrees of left ventricular (LV) dysfunction.

Imprecise increases in heart rate (HR)-rise in HF patients with severe reduction of LV ejection fraction and cardiac electronic implantable devices (CEID) using standard, age-related algorithms does not consistently improve exercise capacity.

In contrast, personalised HR-programming, guided by individuals’ non-invasive force-frequency-relationship (FFR) data does, whilst also promoting better LV function.

Research Question:Do patients with less severe LV systolic dysfunction and persistent symptoms benefit from personalised HR management?

Objectives:To demonstrate the effects of personalised HR management on exercise capacity, LV remodelling and quality of life in people with HF and LVEF 35-50%.

Methods:Participants with LVEF 35-50% and a pre-existing CEID will be randomly allocated to have the rate-adaptive algorithm in their device programmed to: ‘personalised’; ‘standard’; or ‘rate-adaptive-off’ for 6m.

In the ‘personalised’ group, the CEID will maintain the HR within the patient’s optimal range guided by their FFR data. ‘Standard’ care will be age-guided HR-rise programming. In the ‘rate-response-off’ arm, rate-adaptive-mode will be deactivated. Programming and analysis of patient-orientated outcomes will be double-blind.

Outcomes:To describe whether the benefits of tailored HR management extend to patients with less severe LV dysfunction.