Shi-Jun Li1, Ulrik Sartipy1, Lars H Lund1, Ulf Dahlström1, Martin Adiels1, Max Petzold1, Michael Fu2. 1. From the Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, Gothenburg, Sweden (S.-J.L., M.F.); Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China (S.-J.L.); Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, Stockholm, Sweden (U.S.); Department of Molecular Medicine and Surgery (U.S.), Unit of Cardiology, Department of Medicine (L.H.L.), Karolinska Institute, Stockholm, Sweden; Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden (U.D.); and Centre for Applied Biostatistics, University of Gothenburg, Gothenburg, Sweden (M.A., M.P.). 2. From the Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, Gothenburg, Sweden (S.-J.L., M.F.); Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China (S.-J.L.); Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, Stockholm, Sweden (U.S.); Department of Molecular Medicine and Surgery (U.S.), Unit of Cardiology, Department of Medicine (L.H.L.), Karolinska Institute, Stockholm, Sweden; Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden (U.D.); and Centre for Applied Biostatistics, University of Gothenburg, Gothenburg, Sweden (M.A., M.P.). Michael.fu@vgregion.se.
Abstract
BACKGROUND: In heart failure and reduced ejection fraction, the prognostic role of heart rate (HR) in atrial fibrillation (AF) is unknown and the effectiveness of β-blockers has recently been questioned in AF. METHODS AND RESULTS: A total of 18 858 patients with heart failure and reduced ejection fraction registered with Swedish Heart Failure Registry were included in this study: patients with sinus rhythm (SR; n=11 466) and patients with AF (n=7392). The outcome measure was all-cause mortality. Compared with HR ≤60 beats per minute, the adjusted hazard ratios for mortality in SR were 1.26 for HR=61 to 70 beats per minute, 1.37 for HR=71 to 80 beats per minute, 1.52 for HR=81 to 90 beats per minute, 1.63 for HR=91 to 100 beats per minute, and 2.69 for HR >100 beats per minute. However, in AF, the hazard ratio increased only for HR >100 beats per minute (1.30; P=0.001). β-blocker use was associated with reduced mortality in SR (hazard ratio, 0.77; P=0.011) and in AF (hazard ratio, 0·71; P<0.001). For β-blocker use in SR, the hazard ratio gradually increased with HR increment, whereas in AF, the hazard ratio significantly increased only for HR >100 beats per minute (1.29; P=0.003) compared with HR ≤60 beats per minute. CONCLUSIONS: In patients with heart failure and reduced ejection fraction, a higher HR was associated with increased mortality in SR, but in AF, this is true only for HR >100 beats per minute. β-blocker use was associated with reduced mortality both in SR and in AF.
BACKGROUND: In heart failure and reduced ejection fraction, the prognostic role of heart rate (HR) in atrial fibrillation (AF) is unknown and the effectiveness of β-blockers has recently been questioned in AF. METHODS AND RESULTS: A total of 18 858 patients with heart failure and reduced ejection fraction registered with Swedish Heart Failure Registry were included in this study: patients with sinus rhythm (SR; n=11 466) and patients with AF (n=7392). The outcome measure was all-cause mortality. Compared with HR ≤60 beats per minute, the adjusted hazard ratios for mortality in SR were 1.26 for HR=61 to 70 beats per minute, 1.37 for HR=71 to 80 beats per minute, 1.52 for HR=81 to 90 beats per minute, 1.63 for HR=91 to 100 beats per minute, and 2.69 for HR >100 beats per minute. However, in AF, the hazard ratio increased only for HR >100 beats per minute (1.30; P=0.001). β-blocker use was associated with reduced mortality in SR (hazard ratio, 0.77; P=0.011) and in AF (hazard ratio, 0·71; P<0.001). For β-blocker use in SR, the hazard ratio gradually increased with HR increment, whereas in AF, the hazard ratio significantly increased only for HR >100 beats per minute (1.29; P=0.003) compared with HR ≤60 beats per minute. CONCLUSIONS: In patients with heart failure and reduced ejection fraction, a higher HR was associated with increased mortality in SR, but in AF, this is true only for HR >100 beats per minute. β-blocker use was associated with reduced mortality both in SR and in AF.
Authors: Paweł Balsam; Michał Peller; Sonia Borodzicz; Agnieszka Kapłon-Cieślicka; Krzysztof Ozierański; Agata Tymińska; Michał Marchel; Maria G Crespo-Leiro; Aldo Pietro Maggioni; Jarosław Drożdż; Marcin Grabowski; Krzysztof J Filipiak; Grzegorz Opolski Journal: Cardiol J Date: 2018-08-29 Impact factor: 2.737
Authors: Koki Nakanishi; Marco R Di Tullio; Min Qian; John L P Thompson; Arthur J Labovitz; Douglas L Mann; Ralph L Sacco; Patrick M Pullicino; Ronald S Freudenberger; John R Teerlink; Susan Graham; Gregory Y H Lip; Bruce Levin; Jay P Mohr; Richard Buchsbaum; Conrado J Estol; Dirk J Lok; Piotr Ponikowski; Stefan D Anker; Shunichi Homma Journal: Cerebrovasc Dis Date: 2017-04-19 Impact factor: 2.762
Authors: Liang-Han Ling; Peter M Kistler; Jonathan M Kalman; Richard J Schilling; Ross J Hunter Journal: Nat Rev Cardiol Date: 2015-12-10 Impact factor: 32.419
Authors: Òscar Miró; Christian Müller; Francisco Javier Martín-Sánchez; Héctor Bueno; Alexander Mebazaa; Pablo Herrero; Javier Jacob; Víctor Gil; Rosa Escoda; Pere Llorens Journal: Clin Res Cardiol Date: 2016-07-05 Impact factor: 5.460