Predicting maximal HR in heart failure patients on β-blockade therapy.

Journal Article (Journal Article;Multicenter Study)

PURPOSE: Standards for estimating maximal HR are important when interpreting the adequacy of physiologic stress during exercise testing, assessing chronotropic response, and prescribing an exercise training regimen. The equation 220 - age is used to estimate maximum HR; however, it overestimates measured maximal HR in patients taking β-adrenergic blockade (βB) therapy. This study developed and validated a practical equation to predict maximal HR in patients with heart failure (HF) taking βB therapy. METHODS: Data from symptom-limited exercise tests completed on patients with systolic HF participating in the Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training trial and taking a βB agent were used to develop a simplified equation, which was validated using bootstrapping. RESULTS: The simplified derived equation was 119 + 0.5 (resting HR) - 0.5 (age) - (0, if test was completed using a treadmill; 5, if using a stationary bike). The R2 and SEE were 0.28 and 18 beats·min(-1), respectively. Validation of this equation yielded a mean R and SEE of 0.28 and 18 beats·min(-1), respectively. For the equation 220 - age, the R2 was -2.93, and the SEE was 43 beats·min(-1). CONCLUSIONS: We report a valid and simple population-specific equation for estimating peak HR in patients with HF taking βB therapy. This equation should be helpful when evaluating chronotropic response or assessing if a maximum effort was provided during exercise testing. We caution, however, that the magnitude of the variation (SEE = 18 beats·min(-1)) associated with this prediction equation may make it impractical when prescribing exercise intensity.

Full Text

Duke Authors

Cited Authors

  • Keteyian, SJ; Kitzman, D; Zannad, F; Landzberg, J; Arnold, JM; Brubaker, P; Brawner, CA; Bensimhon, D; Hellkamp, AS; Ewald, G

Published Date

  • March 2012

Published In

Volume / Issue

  • 44 / 3

Start / End Page

  • 371 - 376

PubMed ID

  • 21900844

Pubmed Central ID

  • PMC3755356

Electronic International Standard Serial Number (EISSN)

  • 1530-0315

Digital Object Identifier (DOI)

  • 10.1249/MSS.0b013e318234316f


  • eng

Conference Location

  • United States