Kieran F Docherty1, Li Shen1, Davide Castagno2, Mark C Petrie1, William T Abraham3, Michael Böhm4, Akshay S Desai5, Kenneth Dickstein6, Lars V Køber7, Milton Packer8, Jean L Rouleau9, Scott D Solomon5, Karl Swedberg10, Ali Vazir11, Michael R Zile12, Pardeep S Jhund1, John J V McMurray1. 1. BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK. 2. Division of Cardiology, Città della Salute e della Scienza Hospital, Department of Medical Sciences, University of Turin, Torino, Italy. 3. Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH, USA. 4. Department of Internal Medicine III, University Hospital of Saarland, Saarland University, Homburg/Saar, Germany. 5. Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA. 6. Department of Cardiology, University of Bergen, Stavanger University Hospital, Stavanger, Norway. 7. Department of Cardiology, The Heart Centre, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark. 8. Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX, USA. 9. Institut de Cardiologie de Montréal, Université de Montréal, Montréal, Canada. 10. Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden; National Heart and Lung Institute, Imperial College London, London, UK. 11. Department of Cardiology, Royal Brompton Hospital, National Heart and Lung Institute, Imperial College London, London, UK. 12. Department of Medicine, Medical University of South Carolina, Charleston, SC, USA.
Abstract
AIMS: To investigate the relationship between heart rate and outcomes in heart failure and reduced ejection fraction (HFrEF) patients in sinus rhythm (SR) and atrial fibrillation (AF) adjusting for natriuretic peptide concentration, a powerful prognosticator. METHODS AND RESULTS: Of 13 562 patients from two large HFrEF trials, 10 113 (74.6%) were in SR and 3449 (25.4%) in AF. The primary endpoint was the composite of cardiovascular death or heart failure hospitalization. Heart rate was analysed as a categorical (tertiles, T1-3) and continuous variable (per 10 bpm), separately in patients in SR and AF. Outcomes were adjusted for prognostic variables, including N-terminal prohormone of B-type natriuretic peptide (NT-proBNP), and also examined using change from baseline heart rate to 1 year (≤ -10 bpm, ≥ +10 bpm, < ±10 bpm). SR patients with a higher heart rate had worse symptoms and quality of life, more often had diabetes and higher NT-proBNP concentrations. They had higher risk of the primary endpoint [T3 vs. T1 adjusted hazard ratio (HR) 1.50, 95% confidence interval (CI) 1.35-1.66; P < 0.001; per 10 bpm: 1.12, 95% CI 1.09-1.16; P < 0.001]. In SR, heart rate was associated with a relatively higher risk of pump failure than sudden death (adjusted HR per 10 bpm 1.17, 95% CI 1.09-1.26; P < 0.001 vs. 1.07, 95% CI 1.02-1.13; P = 0.011). Heart rate was not predictive of any outcome in AF. CONCLUSIONS: In HFrEF, an elevated heart rate was an independent predictor of adverse cardiovascular outcomes in patients in SR, even after adjustment for NT-proBNP. There was no relationship between heart rate and outcomes in AF. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov Identifiers NCT01035255 and NCT00853658.
AIMS: To investigate the relationship between heart rate and outcomes in heart failure and reduced ejection fraction (HFrEF) patients in sinus rhythm (SR) and atrial fibrillation (AF) adjusting for natriuretic peptide concentration, a powerful prognosticator. METHODS AND RESULTS: Of 13 562 patients from two large HFrEF trials, 10 113 (74.6%) were in SR and 3449 (25.4%) in AF. The primary endpoint was the composite of cardiovascular death or heart failure hospitalization. Heart rate was analysed as a categorical (tertiles, T1-3) and continuous variable (per 10 bpm), separately in patients in SR and AF. Outcomes were adjusted for prognostic variables, including N-terminal prohormone of B-type natriuretic peptide (NT-proBNP), and also examined using change from baseline heart rate to 1 year (≤ -10 bpm, ≥ +10 bpm, < ±10 bpm). SR patients with a higher heart rate had worse symptoms and quality of life, more often had diabetes and higher NT-proBNP concentrations. They had higher risk of the primary endpoint [T3 vs. T1 adjusted hazard ratio (HR) 1.50, 95% confidence interval (CI) 1.35-1.66; P < 0.001; per 10 bpm: 1.12, 95% CI 1.09-1.16; P < 0.001]. In SR, heart rate was associated with a relatively higher risk of pump failure than sudden death (adjusted HR per 10 bpm 1.17, 95% CI 1.09-1.26; P < 0.001 vs. 1.07, 95% CI 1.02-1.13; P = 0.011). Heart rate was not predictive of any outcome in AF. CONCLUSIONS: In HFrEF, an elevated heart rate was an independent predictor of adverse cardiovascular outcomes in patients in SR, even after adjustment for NT-proBNP. There was no relationship between heart rate and outcomes in AF. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov Identifiers NCT01035255 and NCT00853658.
Authors: Lorenzo Stretti; Dauphine Zippo; Andrew J S Coats; Markus S Anker; Stephan von Haehling; Marco Metra; Daniela Tomasoni Journal: ESC Heart Fail Date: 2021-12-16
Authors: Eulalia Muria-Subirats; Josep Lluis Clua-Espuny; Juan Ballesta-Ors; Blanca Lorman-Carbo; Iñigo Lechuga-Duran; Jose Fernández-Saez; Roger Pla-Farnos Journal: Int J Environ Res Public Health Date: 2020-05-16 Impact factor: 4.614