Phillip H Lam1, Daniel J Dooley1, Prakash Deedwania2, Steven N Singh3, Deepak L Bhatt4, Charity J Morgan5, Javed Butler6, Selma F Mohammed7, Wen-Chih Wu8, Gurusher Panjrath9, Michael R Zile10, Michel White11, Cherinne Arundel12, Thomas E Love13, Marc R Blackman14, Richard M Allman15, Wilbert S Aronow16, Stefan D Anker17, Gregg C Fonarow18, Ali Ahmed19. 1. Center for Health and Aging, Veterans Affairs Medical Center, Washington, DC; Department of Medicine, Georgetown University, Washington, DC; Division of Cardiology, MedStar Washington Hospital Center, Washington, DC. 2. Center for Health and Aging, Veterans Affairs Medical Center, Washington, DC; Division of Cardiology, Department of Medicine, University of California, San Francisco, Fresno, California. 3. Department of Medicine, Georgetown University, Washington, DC; Section of Cardiology, Department of Medicine, Veterans Affairs Medical Center, Washington, DC. 4. Department of Medicine, Brigham and Women's Hospital Heart & Vascular Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts. 5. Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama. 6. Division of Cardiology, Department of Medicine, Stony Brook University, Stony Brook, New York. 7. Division of Cardiology, MedStar Washington Hospital Center, Washington, DC. 8. Section of Cardiology, Department of Medicine, Veterans Affairs Medical Center, Providence, Rhode Island; Division of Cardiology, Department of Medicine, Brown University, Providence, Rhode Island. 9. Department of Medicine, George Washington University, Washington, DC. 10. Section of Cardiology, Department of Medicine, Ralph H. Johnson VA Medical Center, Charleston, South Carolina; Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina. 11. Division of Cardiology, Montreal Heart Institute, Department of Medicine, Université de Montréal, Montreal, Quebec, Canada. 12. Department of Medicine, Georgetown University, Washington, DC; Department of Medicine, George Washington University, Washington, DC; Hospitalist Section, Medical Service Department, Veterans Affairs Medical Center, Washington, DC. 13. Department of Medicine, Department of Population and Quantitative Health Sciences, and Center for Health Care Research and Policy, Case Western Reserve University, Cleveland, Ohio. 14. Center for Health and Aging, Veterans Affairs Medical Center, Washington, DC; Department of Medicine, Georgetown University, Washington, DC; Department of Medicine, George Washington University, Washington, DC. 15. Geriatrics and Extended Care, Department of Veterans Affairs, Washington, DC. 16. Division of Cardiology, Department of Medicine, Westchester Medical Center, Valhalla, New York; Division of Cardiology, Department of Medicine, New York Medical College, Valhalla, New York. 17. Division of Cardiology and Metabolism-Heart Failure, Cachexia & Sarcopenia, Department of Cardiology (CVK), Berlin-Brandenburg Center for Regenerative Therapies (BCRT), and Deutsches Zentrum für Herz-Kreislauf-Forschung (German Centre for Cardiovascular Research), Charité-Universitätsmedizin Berlin, Berlin, Germany; Department of Cardiology and Pneumology, University Medicine Göttingen, Göttingen, Germany. 18. Division of Cardiology, Department of Medicine, University of California, Los Angeles, Los Angeles, California. 19. Center for Health and Aging, Veterans Affairs Medical Center, Washington, DC; Department of Medicine, George Washington University, Washington, DC; Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama. Electronic address: aliahmedmdmph@gmail.com.
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. Published by Elsevier Inc.
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. Published by Elsevier Inc.
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