Great debate on the heart rate reduction issue
　　At the Congress， we had a very nice debate on the heart rate reduction issue between my American colleague Barry Massie， who is the President of the Heart Failure Association of America， and Michael Bohm who is a German colleague. The debate was based on the results of the SHIFT study. The question raised was whether an additional reduction in heart rate using a drug which selectively inhibits currents in the sinus node and therefore reducing heart rate， would be able to affect outcomes. The consensus was that the first choice of drug is obviously a beta-blocker and perhaps now that awareness is broadening， heart rate is seen not only as a marker of a good outcome but also a risk factor in patients with chronic heart failure. As a risk factor， we may consider this a therapeutic target and indeed， we have evidence from beta-blocker trials that the magnitude of a heart rate reduction in the beta-blocker trials correlates to the magnitude of the benefit. So the evidence for beta-blockers is there and the SHIFT study provided the evidence that an additional reduction in heart rate using ivabradine can further improve outcomes. Obviously the problem is how this will translate into clinical practice. I guess the simple answer would be to optimize the beta-blocker therapy first and if the heart rate is still above 70， (and that was the criteria included in the SHIFT study)， then you should strongly consider adding this therapy on top of already existing therapy， provided the patient has a normal sinus rhythm because the drug only works in patients with sinus rhythm.
　　2011欧洲心力衰竭大会的主题和亮点
　　本届大会的主题是处理常见的合并症，此为临床指南中重要的组成部分。此次会议讨论了HF的多种合并症，其中最重要的是房颤。有关房颤的会议重点讨论如何处理HF合并房颤的患者，包括药物和非药物（即导管消融）治疗。同时，还讨论HF合并贫血和铁缺乏症、HF合并肾功能不全即心-肾综合征以及HF合并糖尿病等诸多问题。对于HF伴有二尖瓣关闭不全的患者，如今有许多颇有前途的方法，如二尖瓣钳，对于严格挑选的患者不失为一种较好的选择。
　　两项有关远程医疗的研究
　　TIM-HF试验是一项关于如何应用远程医疗优化HF患者的治疗但结果中立的研究。TEHAF试验是定位于护理系统的第二项远程医疗研究，结果表明，远程医疗可减少有HF病史患者的再入院。
　　有关减慢心率的辩论
　　基于SHIFT研究的结果，Barry Massie教授和Michael Bohm教授就减慢心率问题展开辩论——应用选择性抑制窦房结的药物进一步减慢心率能否影响预后。心率不仅是良好预后的标志，也是CHF的危险因素。SHIFT研究证实，应用伊伐布雷定（ivabradine）额外降低心率能进一步改善结局。现在的问题在于如何将试验结果转化为临床实践，简单的方案为首先优化β受体阻滞剂治疗，若心率仍然＞70 bpm（这是SHIFT研究中的标准），应考虑此种强化治疗。