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

Phillip H. Lam, Daniel J. Dooley, Prakash Deedwania, Steven N. Singh, Deepak L. Bhatt, Charity J. Morgan, Javed Butler, Selma F. Mohammed, Wen Chih Wu, Gurusher Panjrath, Michael R. Zile, Michel White, Cherinne Arundel, Thomas E. Love, Marc R. Blackman, Richard M. Allman, Wilbert S. Aronow, Stefan D. Anker, Gregg C. Fonarow, Ali Ahmed

Research output: Contribution to journalArticle

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

Original languageEnglish (US)
Pages (from-to)1861-1871
Number of pages11
JournalJournal of the American College of Cardiology
Volume70
Issue number15
DOIs
StatePublished - Oct 10 2017

Keywords

  • all-cause mortality
  • all-cause readmission
  • atrial fibrillation
  • beta-blockers
  • propensity score

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Lam, P. H., Dooley, D. J., Deedwania, P., Singh, S. N., Bhatt, D. L., Morgan, C. J., Butler, J., Mohammed, S. F., Wu, W. C., Panjrath, G., Zile, M. R., White, M., Arundel, C., Love, T. E., Blackman, M. R., Allman, R. M., Aronow, W. S., Anker, S. D., Fonarow, G. C., & Ahmed, A. (2017). Heart Rate and Outcomes in Hospitalized Patients With Heart Failure With Preserved Ejection Fraction. Journal of the American College of Cardiology, 70(15), 1861-1871. https://doi.org/10.1016/j.jacc.2017.08.022