Jason G Andrade1, Denis Roy1, D George Wyse2, Jean-Claude Tardif3, Mario Talajic1, Hugues Leduc4, Julia-Cadrin Tourigny1, Azadeh Shohoudi4, Marc Dubuc1, Léna Rivard1, Peter G Guerra1, Bernard Thibault1, Katia Dyrda1, Laurent Macle1, Paul Khairy5. 1. Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada. 2. Libin Cardiovascular Institute, Calgary, Alberta, Canada. 3. Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada; Montreal Heart Institute Coordinating Center, Montreal, Quebec, Canada. 4. Montreal Heart Institute Coordinating Center, Montreal, Quebec, Canada. 5. Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada; Montreal Heart Institute Coordinating Center, Montreal, Quebec, Canada. Electronic address: paul.khairy@umontreal.ca.
Abstract
BACKGROUND: An elevated resting heart rate has been associated with adverse cardiovascular outcomes. Its prognostic value has not specifically been examined in patients with atrial fibrillation. OBJECTIVE: The purpose of this study was to assess the relationship between resting heart rate measured in sinus rhythm and in atrial fibrillation and subsequent hospitalizations and death. METHODS: An analysis of individual patient-level data from subjects enrolled in the AFFIRM and AF-CHF trials was conducted to determine the impact of resting heart rate on hospitalizations and mortality. Separate analyses were performed in atrial fibrillation and sinus rhythm. A total of 7159 baseline ECGs (4848 in atrial fibrillation, 2311 in sinus rhythm) were analyzed in 5164 patients (34.8% female, age 68.2 ± 8.3 years). RESULTS: During mean follow-up of 40.8 ± 16.3 months, 1016 patients died (668 cardiovascular deaths), and 3150 required at least 1 hospitalization (2215 cardiovascular). An elevated baseline heart rate in sinus rhythm was associated with increased all-cause mortality [hazard ratio (HR) 1.24 per 10 bpm increase, 95% confidence interval (CI) 1.14-1.36, P < .0001]. In contrast, a baseline heart rate in atrial fibrillation was not associated with mortality. However, compared to heart rates 90-114 bpm in atrial fibrillation, a heart rate >114 bpm was independently associated with all-cause (HR 1.18, 95% CI 1.06-1.31, P = .0018) and cardiovascular (HR 1.25, 95% CI 1.10-1.42, P = .0005) hospitalizations. CONCLUSION: In patients with a history of atrial fibrillation, an elevated baseline heart rate in sinus rhythm is independently associated with mortality. In contrast, the baseline heart rate in atrial fibrillation is not associated with mortality but predicts hospitalizations.
RCT Entities:
BACKGROUND: An elevated resting heart rate has been associated with adverse cardiovascular outcomes. Its prognostic value has not specifically been examined in patients with atrial fibrillation. OBJECTIVE: The purpose of this study was to assess the relationship between resting heart rate measured in sinus rhythm and in atrial fibrillation and subsequent hospitalizations and death. METHODS: An analysis of individual patient-level data from subjects enrolled in the AFFIRM and AF-CHF trials was conducted to determine the impact of resting heart rate on hospitalizations and mortality. Separate analyses were performed in atrial fibrillation and sinus rhythm. A total of 7159 baseline ECGs (4848 in atrial fibrillation, 2311 in sinus rhythm) were analyzed in 5164 patients (34.8% female, age 68.2 ± 8.3 years). RESULTS: During mean follow-up of 40.8 ± 16.3 months, 1016 patients died (668 cardiovascular deaths), and 3150 required at least 1 hospitalization (2215 cardiovascular). An elevated baseline heart rate in sinus rhythm was associated with increased all-cause mortality [hazard ratio (HR) 1.24 per 10 bpm increase, 95% confidence interval (CI) 1.14-1.36, P < .0001]. In contrast, a baseline heart rate in atrial fibrillation was not associated with mortality. However, compared to heart rates 90-114 bpm in atrial fibrillation, a heart rate >114 bpm was independently associated with all-cause (HR 1.18, 95% CI 1.06-1.31, P = .0018) and cardiovascular (HR 1.25, 95% CI 1.10-1.42, P = .0005) hospitalizations. CONCLUSION: In patients with a history of atrial fibrillation, an elevated baseline heart rate in sinus rhythm is independently associated with mortality. In contrast, the baseline heart rate in atrial fibrillation is not associated with mortality but predicts hospitalizations.
Authors: Aurore Lyon; Manouk van Mourik; Laura Cruts; Jordi Heijman; Sebastiaan C A M Bekkers; Ulrich Schotten; Harry J G M Crijns; Dominik Linz; Joost Lumens Journal: Europace Date: 2021-03-04 Impact factor: 5.214
Authors: Uma N Srivatsa; Guibo Xing; Ezra Amsterdam; Nipavan Chiamvimonvat; Nayereh Pezeshkian; Dali Fan; Richard H White Journal: J Atr Fibrillation Date: 2018-06-30
Authors: Michael Kühne; Christine S Zuern; Peter Hämmerle; Stefanie Aeschbacher; Anne Springer; Ceylan Eken; Michael Coslovsky; Gilles Dutilh; Giorgio Moschovitis; Nicolas Rodondi; Patricia Chocano; David Conen; Stefan Osswald Journal: Clin Res Cardiol Date: 2021-06-22 Impact factor: 5.460