2017 Issues   /   December 2017

All-Cause Mortality Reduced in Heart Failure Patients with Lower Discharge Heart Rate

By U.S. Medicine

WASHINGTON — Although a lower heart rate is known to be linked with better outcomes in patients with heart failure (HF) with reduced ejection fraction (EF), not as much research is available on the association in patients with HF with preserved ejection fraction (HFpEF).

A study published in the Journal of the American College of Cardiology reported the results of a study examining discharge heart rate with outcomes in hospitalized patients with HFpEF.1

[Click on Image to See Enlarged Version]

Researchers from the Center for Health and Aging at the Washington, DC, VAMC and VA institutions around the nation focused on 8,873 hospitalized patients with HFpEF and an EF of 50% or greater in the Medicare-linked OPTIMIZE-HF (Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure) registry. Of those patients, 6,286 had a stable heart rate, defined as 20 or less beats/min variation between admission and discharge. A subset of 38% had a discharge heart rate of less than 70 beats/min.

The researchers used propensity scores for discharge heart rate of less than 70 beats/min, estimated for each of the 6,286 patients, to create a cohort of 2,031 pairs of patients with heart rate less than 70 beats/min vs. 70 or higher beats/min, balanced on 58 baseline characteristics. Most of the 4,062 matched patients, with a mean age of 79, were women and only 10% were African-American.

Results indicated that during a total of six years, with a median 2.8 years, of follow-up, all-cause mortality was 65% vs. 70% for matched patients with a discharge heart rate less than 70 beats/min compared to those with heart rates 70 or higher beats/min, for a hazard ratio (HR) of 0.86. A heart rate of less than 70 beats/min was also associated with a lower risk for the combined endpoint of HF readmission or all-cause mortality – with an HR of 0.90 — but not with HF readmission (HR: 0.93)) or all-cause readmission (HR: 1.01).

Study authors pointed out that heart rhythm or use of beta-blockers had no effect on the results, concluding, “Among hospitalized patients with HFpEF, a lower discharge heart rate was independently associated with a lower risk of all-cause mortality, but not readmission.”

  1. Lam PH, Dooley DJ, Deedwania P, Singh SN, Bhatt DL, Morgan CJ, Butler J, Mohammed SF, Wu WC, Panjrath G, Zile MR, White M, Arundel C, Love TE, Blackman MR, Allman RM, Aronow WS, Anker SD, Fonarow GC, Ahmed A. Heart Rate and Outcomes in Hospitalized Patients With Heart Failure With Preserved Ejection Fraction. JAm Coll Cardiol. 2017 Oct 10;70(15):1861-1871. doi: 10.1016/j.jacc.2017.08.022.PubMed PMID: 28982499.

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