Occurrence of composite cardiac endpoints with change in resting heart rate among Chinese patients with coronary artery disease: Chinese cohort from the real-world BISO-CAD study

Objective: We evaluated change in resting heart rate (RHR) and its impact on prognosis in Chinese coronary artery disease (CAD) patients treated with bisoprolol, and also assessed drug safety and tolerability. Methods: This phase IV, single arm observational study was a sub-study of the BISO-CAD study conducted across 20 hospitals in China between October 2011 and July 2015 with follow-up at 6, 12 and 18 months after baseline. The primary endpoint was occurrence of composite cardiac events. Results: A total of 663 CAD patients (baseline RHR 75.47 ± 6.62 bpm) were enrolled in the intent-to-treat (ITT) set, and 513 patients were included in the efficacy analysis (EA) set. In the ITT set, the risk and the number of composite cardiac events in patients with mean RHR 69–74 bpm were significantly higher than in the <65 bpm group (ITT: estimate 1.03 ± 0.47, p =.029). The incidence of the composite cardiac endpoint was not affected by continuous mean RHR (p =.5070). RHR significantly decreased from baseline to 18 months, most obviously in the first 6 months (p <.0001). Ejection fraction and fractional shortening significantly improved in both the ITT and EA sets. An average RHR of 69–74 bpm had a significant effect on admission to hospital for acute coronary syndrome in the ITT (estimate 1.10, HR 3.004, p =.0196) and EA (estimate 1.26, HR 3.526, p =.0132) groups. Seven (1.1%) patients reported drug related adverse events. Conclusion: Reduction in RHR with bisoprolol lowered the incidence of composite cardiac events along with an acceptable safety and tolerability profile.