Effect of Pathway Training on Rest Heart Rate and the Application of Β-Blocker in Coronary Heart Disease Patients: an Open-Label, Multi-Center, Prospective Study

OBJECTIVE:To explore the mean resting heart rate (RHR), usage and safety status of β-blocker, and associated changes after conducting clinical pathway training on patients with coronary heart disease(CHD).METHODS:We performed an open-label, multi-center prospective study. The ethical approval documents was prepared before the study. A total of 3 204 hospitalized participants with CHD were enrolled, from June 2012 to February 2013 in 24 hospitals in Beijing, and informed consent was obtained from each patients this trial was divided into two continuous stages (each stage lasted for 8 weeks). 1 570 participants were enrolled at the first stage, the clinicians used the standard method to administer β-blockers to these patients. At the second stage, β-blockers were administered to 1 634 enrolled patients by trained clinicians. The mean RHR, β-blocker usage status were recorded on the day of admission and discharge. We also described adverse events and severe adverse events.RESULTS:The average RHR at baseline and discharge were (71 ± 13) bpm and (63 ± 9) bpm. The proportion of patients reaching the RHR goals when discharged was 35.9% in stage 1 vs 48.3% (P < 0.001) in stage 2. The rate of β-blocker usage was 80.1% vs 81.0% (P = 0.162) in stage 1, 90.3% vs 91.3% (P < 0.001) in stage 2. The average dose of metoprolol succinate sustained-release tablet was (38 ± 18) vs (39 ± 42) mg/d (P < 0.001) in stage 1, (40 ± 23) vs (46 ± 23) mg/d (P < 0.001) in stage 2. The severe adverse events at both stages had no significant differences.CONCLUSION:The proportion of patients with CHD reaching the RHR goals and the average dose of β-blocker was low. However, the proportion of patients reaching the RHR goals, the rate of β-blocker usage and the average dose of β-blocker were all increased after clinical pathway training.