Ali Vazir1, Brian Claggett2, Bertram Pitt3, Inder Anand4, Nancy Sweitzer5, James Fang6, Jerome Fleg7, Jean Rouleau8, Sanjiv Shah9, Marc A Pfeffer2, Scott D Solomon10. 1. Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Massachusetts; Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust and Institute of Cardiovascular Medicine and Sciences, National Heart and Lung Institute, Imperial College London, London, United Kingdom. 2. Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Massachusetts. 3. University of Michigan Medical School, Ann Arbor, Michigan. 4. Division of Cardiology, University of Minnesota, Minneapolis. 5. Division of Cardiovascular Medicine, University of Arizona, Tucson, Arizona. 6. Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah. 7. National Heart, Lung, and Blood Institute, Division of Cardiovascular Sciences, Bethesda, Maryland. 8. Department of Medicine/Cardiology, Montréal Heart Institute, Université de Montréal, Montréal, Québec, Canada. 9. Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois. 10. Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Massachusetts. Electronic address: ssolomon@rics.bwh.harvard.edu.
Abstract
OBJECTIVES: The aim of this study was to examine the relationship between baseline heart rate (HR), change in HR from a preceding visit, and time-updated HR with subsequent outcomes in patients with heart failure with preserved ejection fraction (HFpEF) in the TOPCAT (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist) trial. BACKGROUND: Higher resting HR and increase in HR over time in patients with heart failure are associated with adverse outcomes. Whether these relationships between HR and prognosis are also observed in patients with HFpEF requires further assessment. METHODS: In 1,767 patients enrolled in theTOPCAT trial from the Americas, the associations between baseline resting HR and change in HR from the preceding visit and clinical outcomes were examined using Cox proportional hazards models, along with the association between HR at each visit and outcome. RESULTS: Both baseline HR (adjusted hazard ratio: 1.08; 95% confidence interval: 1.04 to 1.12) and change in HR from the preceding visit (adjusted hazard ratio: 1.09; 95% confidence interval: 1.05 to 1.14; p < 0.001 per 5 beats/min higher HR), after adjusting for covariates, were associated with a higher risk for the primary endpoint of cardiovascular death, hospitalization for HF, or aborted cardiac arrest. Time-updated resting HR at each visit was also associated with risk (adjusted hazard ratio: 1.11; 95% confidence interval: 1.07 to 1.15; p < 0.001 per 5 beats/min higher HR). Furthermore, a rise in resting HR of approximately 10 beats/min, beginning approximately 10 days prior to the primary endpoint, was observed. CONCLUSIONS: Baseline resting HR and change in HR over time predict outcomes in patients with HFpEF, as does time-updated HR during follow-up. These data suggest that frequent outpatient monitoring of HR, possibly with remote technologies, may identify patients with HFpEF who may be at increased risk for rehospitalization or death.
RCT Entities:
OBJECTIVES: The aim of this study was to examine the relationship between baseline heart rate (HR), change in HR from a preceding visit, and time-updated HR with subsequent outcomes in patients with heart failure with preserved ejection fraction (HFpEF) in the TOPCAT (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist) trial. BACKGROUND: Higher resting HR and increase in HR over time in patients with heart failure are associated with adverse outcomes. Whether these relationships between HR and prognosis are also observed in patients with HFpEF requires further assessment. METHODS: In 1,767 patients enrolled in the TOPCAT trial from the Americas, the associations between baseline resting HR and change in HR from the preceding visit and clinical outcomes were examined using Cox proportional hazards models, along with the association between HR at each visit and outcome. RESULTS: Both baseline HR (adjusted hazard ratio: 1.08; 95% confidence interval: 1.04 to 1.12) and change in HR from the preceding visit (adjusted hazard ratio: 1.09; 95% confidence interval: 1.05 to 1.14; p < 0.001 per 5 beats/min higher HR), after adjusting for covariates, were associated with a higher risk for the primary endpoint of cardiovascular death, hospitalization for HF, or aborted cardiac arrest. Time-updated resting HR at each visit was also associated with risk (adjusted hazard ratio: 1.11; 95% confidence interval: 1.07 to 1.15; p < 0.001 per 5 beats/min higher HR). Furthermore, a rise in resting HR of approximately 10 beats/min, beginning approximately 10 days prior to the primary endpoint, was observed. CONCLUSIONS: Baseline resting HR and change in HR over time predict outcomes in patients with HFpEF, as does time-updated HR during follow-up. These data suggest that frequent outpatient monitoring of HR, possibly with remote technologies, may identify patients with HFpEF who may be at increased risk for rehospitalization or death.
Authors: Ali Vazir; Brian Claggett; Susan Cheng; Hicham Skali; Amil Shah; David Agulair; Christie Mitchell Ballantyne; Orly Vardeny; Scott D Solomon Journal: JAMA Cardiol Date: 2018-03-01 Impact factor: 14.676
Authors: Amanda K Verma; Jie-Lena Sun; Adrian Hernandez; John R Teerlink; Phillip J Schulte; Justin Ezekowitz; Adriaan Voors; Randall Starling; Paul Armstrong; Christopher M O'Conner; Robert J Mentz Journal: Clin Cardiol Date: 2018-07-17 Impact factor: 2.882
Authors: Brian P Halliday; Ali Vazir; Ruth Owen; John Gregson; Rebecca Wassall; Amrit S Lota; Zohya Khalique; Upasana Tayal; Richard E Jones; Daniel Hammersley; Antonis Pantazis; A John Baksi; Stuart Rosen; Dudley J Pennell; Martin R Cowie; John G F Cleland; Sanjay K Prasad Journal: JACC Heart Fail Date: 2021-06-09 Impact factor: 12.035