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

by Lam, Phillip H; Dooley, Daniel J; Mohammed, Selma F.
Citation: Journal of the American College of Cardiology. 70(15):1861-1871, 2017 Oct 10.Journal: Journal of the American College of Cardiology.Published: 2017ISSN: 0735-1097.Full author list: Lam PH; Dooley DJ; Deedwania P; Singh SN; Bhatt DL; Morgan CJ; Butler J; Mohammed SF; Wu WC; Panjrath G; Zile MR; White M; Arundel C; Love TE; Blackman MR; Allman RM; Aronow WS; Anker SD; Fonarow GC; Ahmed A.UI/PMID: 28982499.Subject(s): 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] | *Heart Failure | *Heart Rate | 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] | *Patient Readmission/sn [Statistics & Numerical Data] | Proportional Hazards Models | Registries | Risk Assessment | *Stroke Volume | United States/ep [Epidemiology]Institution(s): MedStar Heart & Vascular InstituteActivity type: Journal Article.Medline article type(s): Journal ArticleOnline resources: Click here to access online Digital Object Identifier: (Click here) Abbreviated citation: J Am Coll Cardiol. 70(15):1861-1871, 2017 Oct 10.Local Holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library:1999-2007.Abstract: 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).Abstract: OBJECTIVES: The aims of this study were to examine associations of discharge heart rate with outcomes in hospitalized patients with HFpEF.Abstract: 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.Abstract: 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.Abstract: 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.

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