Heart Rate and Outcomes in Hospitalized Patients With Heart Failure With Preserved Ejection Fraction. - 2017

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.


English

0735-1097


*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]


MedStar Heart & Vascular Institute


Journal Article