Heart Rate and Outcomes in Hospitalized Patients With Heart Failure With Preserved Ejection Fraction.

MedStar author(s):
Citation: Journal of the American College of Cardiology. 70(15):1861-1871, 2017 Oct 10PMID: 28982499Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Heart Failure | *Heart Rate | *Patient Readmission/sn [Statistics & Numerical Data] | *Stroke Volume | Adrenergic beta-Antagonists/tu [Therapeutic Use] | Aged | Aged, 80 and over | Female | Follow-Up Studies | Heart Failure/di [Diagnosis] | Heart Failure/mo [Mortality] | Heart Failure/pp [Physiopathology] | Heart Failure/th [Therapy] | Hospitalization/sn [Statistics & Numerical Data] | Humans | Male | Medicare/sn [Statistics & Numerical Data] | Mortality | Outcome and Process Assessment (Health Care) | Patient Acuity | Patient Discharge/sn [Statistics & Numerical Data] | Proportional Hazards Models | Registries | Risk Assessment | United States/ep [Epidemiology]Year: 2017Local holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library:1999-2007ISSN:
  • 0735-1097
Name of journal: Journal of the American College of CardiologyAbstract: BACKGROUND: A lower heart rate is associated with better outcomes in patients with heart failure (HF) with reduced ejection fraction (EF). Less is known about this association in patients with HF with preserved ejection fraction (HFpEF).CONCLUSIONS: Among hospitalized patients with HFpEF, a lower discharge heart rate was independently associated with a lower risk of all-cause mortality, but not readmission. Copyright Published by Elsevier Inc.METHODS: Of the 8,873 hospitalized patients with HFpEF (EF >=50%) in the Medicare-linked OPTIMIZE-HF (Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure) registry, 6,286 had a stable heart rate, defined as <=20 beats/min variation between admission and discharge. Of these, 2,369 (38%) had a discharge heart rate of <70 beats/min. Propensity scores for discharge heart rate <70 beats/min, estimated for each of the 6,286 patients, were used to assemble a cohort of 2,031 pairs of patients with heart rate <70 versus >=70 beats/min, balanced on 58 baseline characteristics.OBJECTIVES: The aims of this study were to examine associations of discharge heart rate with outcomes in hospitalized patients with HFpEF.RESULTS: The 4,062 matched patients had a mean age of 79 +/- 10 years, 66% were women, and 10% were African American. During 6 years (median 2.8 years) of follow-up, all-cause mortality was 65% versus 70% for matched patients with a discharge heart rate <70 versus >=70 beats/min, respectively (hazard ratio [HR]: 0.86; 95% confidence interval [CI]: 0.80 to 0.93; p < 0.001). A heart rate <70 beats/min was also associated with a lower risk for the combined endpoint of HF readmission or all-cause mortality (HR: 0.90; 95% CI: 0.84 to 0.96; p = 0.002), but not with HF readmission (HR: 0.93; 95% CI: 0.85 to 1.01) or all-cause readmission (HR: 1.01; 95% CI: 0.95 to 1.08). Similar associations were observed regardless of heart rhythm or receipt of beta-blockers.All authors: Ahmed A, Allman RM, Anker SD, Aronow WS, Arundel C, Bhatt DL, Blackman MR, Butler J, Deedwania P, Dooley DJ, Fonarow GC, Lam PH, Love TE, Mohammed SF, Morgan CJ, Panjrath G, Singh SN, White M, Wu WC, Zile MRFiscal year: FY2018Digital Object Identifier: Date added to catalog: 2017-10-17
Holdings
Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 28982499 Available 28982499

Available online from MWHC library: 1995 - present, Available in print through MWHC library:1999-2007

BACKGROUND: A lower heart rate is associated with better outcomes in patients with heart failure (HF) with reduced ejection fraction (EF). Less is known about this association in patients with HF with preserved ejection fraction (HFpEF).

CONCLUSIONS: Among hospitalized patients with HFpEF, a lower discharge heart rate was independently associated with a lower risk of all-cause mortality, but not readmission. Copyright Published by Elsevier Inc.

METHODS: Of the 8,873 hospitalized patients with HFpEF (EF >=50%) in the Medicare-linked OPTIMIZE-HF (Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure) registry, 6,286 had a stable heart rate, defined as <=20 beats/min variation between admission and discharge. Of these, 2,369 (38%) had a discharge heart rate of <70 beats/min. Propensity scores for discharge heart rate <70 beats/min, estimated for each of the 6,286 patients, were used to assemble a cohort of 2,031 pairs of patients with heart rate <70 versus >=70 beats/min, balanced on 58 baseline characteristics.

OBJECTIVES: The aims of this study were to examine associations of discharge heart rate with outcomes in hospitalized patients with HFpEF.

RESULTS: The 4,062 matched patients had a mean age of 79 +/- 10 years, 66% were women, and 10% were African American. During 6 years (median 2.8 years) of follow-up, all-cause mortality was 65% versus 70% for matched patients with a discharge heart rate <70 versus >=70 beats/min, respectively (hazard ratio [HR]: 0.86; 95% confidence interval [CI]: 0.80 to 0.93; p < 0.001). A heart rate <70 beats/min was also associated with a lower risk for the combined endpoint of HF readmission or all-cause mortality (HR: 0.90; 95% CI: 0.84 to 0.96; p = 0.002), but not with HF readmission (HR: 0.93; 95% CI: 0.85 to 1.01) or all-cause readmission (HR: 1.01; 95% CI: 0.95 to 1.08). Similar associations were observed regardless of heart rhythm or receipt of beta-blockers.

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