Adherence to optimal heart rate control in heart failure with reduced ejection fraction: insight from a survey of heart rate in heart failure in Sweden (HR-HF study).

INTRODUCTION: Despite that heart rate (HR) control is one of the guideline-recommended treatment goals for heart failure (HF) patients, implementation has been painstakingly slow. Therefore, it would be important to identify patients who have not yet achieved their target heart rates and assess possible underlying reasons as to why the target rates are not met. MATERIALS AND METHODS: The survey of HR in patients with HF in Sweden (HR-HF survey) is an investigator-initiated, prospective, multicenter, observational longitudinal study designed to investigate the state of the art in the control of HR in HF and to explore potential underlying mechanisms for suboptimal HR control with focus on awareness of and adherence to guidelines for HR control among physicians who focus on the contributing role of beta-blockers (BBs). RESULTS: In 734 HF patients the mean HR was 68 ± 12 beats per minute (bpm) (37.2% of the patients had a HR >70 bpm). Patients with HF with reduced ejection fraction (HFrEF) (n = 425) had the highest HR (70 ± 13 bpm, with 42% >70 bpm), followed by HF with preserved ejection fraction and HF with mid-range ejection fraction. Atrial fibrillation, irrespective of HF type, had higher HR than sinus rhythm. A similar pattern was observed with BB treatment. Moreover, non-achievement of the recommended target HR (<70 bpm) in HFrEF and sinus rhythm was unrelated to age, sex, cardiovascular risk factors, cardiovascular diseases, and comorbidities, but was related to EF and the clinical decision of the physician. Approximately 50% of the physicians considered a HR of >70 bpm optimal and an equal number considered a HR of >70 bpm too high, but without recommending further action. Furthermore, suboptimal HR control cannot be attributed to the use of BBs because there was neither a difference in use of BBs nor an interaction with BBs for HR >70 bpm compared with HR <70 bpm. CONCLUSION: Suboptimal control of HR was noted in HFrEF with sinus rhythm, which appeared to be attributable to physician decision making rather than to the use of BBs. Therefore, our results underline the need for greater attention to HR control in patients with HFrEF and sinus rhythm and thus a potential for improved HF care.

In situ measurements of the physical characteristics of Titan's environment.

On the basis of previous ground-based and fly-by information, we knew that Titan's atmosphere was mainly nitrogen, with some methane, but its temperature and pressure profiles were poorly constrained because of uncertainties in the detailed composition. The extent of atmospheric electricity ('lightning') was also hitherto unknown. Here we report the temperature and density profiles, as determined by the Huygens Atmospheric Structure Instrument (HASI), from an altitude of 1,400 km down to the surface. In the upper part of the atmosphere, the temperature and density were both higher than expected. There is a lower ionospheric layer between 140 km and 40 km, with electrical conductivity peaking near 60 km. We may also have seen the signature of lightning. At the surface, the temperature was 93.65 +/- 0.25 K, and the pressure was 1,467 +/- 1 hPa.

A sophisticated lander for scientific exploration of Mars: scientific objectives and implementation of the Mars-96 Small Station.

A mission to Mars including two Small Stations, two Penetrators and an Orbiter was launched at Baikonur, Kazakhstan, on 16 November 1996. This was called the Mars-96 mission. The Small Stations were expected to land in September 1997 (Ls approximately 178 degrees), nominally to Amazonis-Arcadia region on locations (33 N, 169.4 W) and (37.6 N, 161.9 W). The fourth stage of the Mars-96 launcher malfunctioned and hence the mission was lost. However, the state of the art concept of the Small Station can be applied to future Martian lander missions. Also, from the manufacturing and performance point of view, the Mars-96 Small Station could be built as such at low cost, and be fairly easily accommodated on almost any forthcoming Martian mission. This is primarily due to the very simple interface between the Small Station and the spacecraft. The Small Station is a sophisticated piece of equipment. With the total available power of approximately 400 mW the Station successfully supports an ambitious scientific program. The Station accommodates a panoramic camera, an alpha-proton-x-ray spectrometer, a seismometer, a magnetometer, an oxidant instrument, equipment for meteorological observations, and sensors for atmospheric measurement during the descent phase, including images taken by a descent phase camera. The total mass of the Small Station with payload on the Martian surface, including the airbags, is only 32 kg. Lander observations on the surface of Mars combined with data from Orbiter instruments will shed light on the contemporary Mars and its evolution. As in the Mars-96 mission, specific science goals could be exploration of the interior and surface of Mars, investigation of the structure and dynamics of the atmosphere, the role of water and other materials containing volatiles and in situ studies of the atmospheric boundary layer processes. To achieve the scientific goals of the mission the lander should carry a versatile set of instruments. The Small Station accommodates devices for atmospheric measurements, geophysical and geochemical studies of the Martian surface and interior, and cameras for descent phase and panoramic views. These instruments would be able to contribute remarkably to the process of solving some of the scientific puzzles of Mars.