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. 2019 Dec 4:26:100444.
doi: 10.1016/j.ijcha.2019.100444. eCollection 2020 Feb.

Prognostic value of discharge heart rate in acute heart failure patients: More relevant in atrial fibrillation?

Agra Bermejo Rosa  1   2 , Pascual-Figal Domingo  2   3 , Gude Sampedro Francisco  2   4 , Delgado Jiménez Juan  2   5 , Vidal Pérez Rafael  1   2 , Gómez Otero Inés  1   2 , Ferrero-Gregori Andreu  2   6 , Álvarez-García Jesús  2   6 , Worner Diz Fernando  7 , Segovia Jesús  2   8 , Crespo-Leiro María Generosa  2   9 , Cinca Cuscullol Juan  2   6 , Fernández Avilés Francisco  2   10   11 , Gónzalez-Juanatey Jose Ramón  1   2 ; Red Española de Insuficiencia Cardiaca researchers (REDINSCOR II)
Affiliations

Prognostic value of discharge heart rate in acute heart failure patients: More relevant in atrial fibrillation?

Agra Bermejo Rosa et al. Int J Cardiol Heart Vasc. .

Abstract

Aims: The prognostic impact of heart rate (HR) in acute heart failure (AHF) patients is not well known especially in atrial fibrillation (AF) patients. The aim of the study was to evaluate the impact of admission HR, discharge HR, HR difference (admission-discharge) in AHF patients with sinus rhythm (SR) or AF on long- term outcomes.

Methods: We included 1398 patients consecutively admitted with AHF between October 2013 and December 2014 from a national multicentre, prospective registry. Logistic regression models were used to estimate the association between admission HR, discharge HR and HR difference and one- year all-cause mortality and HF readmission.

Results: The mean age of the study population was 72 ± 12 years. Of these, 594 (42.4%) were female, 655 (77.8%) were hypertensive and 655 (46.8%) had diabetes. Among all included patients, 745 (53.2%) had sinus rhythm and 653 (46.7%) had atrial fibrillation. Only discharge HR was associated with one year all-cause mortality (Relative risk (RR) = 1.182, confidence interval (CI) 95% 1.024-1.366, p = 0.022) in SR. In AF patients discharge HR was associated with one year all cause mortality (RR = 1.276, CI 95% 1.115-1.459, p ≤ 0.001). We did not observe a prognostic effect of admission HR or HRD on long-term outcomes in both groups. This relationship is not dependent on left ventricular ejection fraction.

Conclusions: In AHF patients lower discharge HR, neither the admission nor the difference, is associated with better long-term outcomes especially in AF patients.

Keywords: Acute heart failure; Atrial fibrillation; Heart rate; Mortality; Sinus rhythm.

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Conflict of interest statement

We declare that we have no conflict of interest.

Figures

Fig. 1
Fig. 1
Effect of post-discharge heart rate on one year all cause mortality, cardiovascular mortality and heart failure readmission in sinus rhythm (A) and atrial fibrillation (B) patients.
Fig. 2
Fig. 2
The area under the time-dependent ROC [AUC(t)] of discharge Heart rate in sinus rhythm and atrial fibrillation patients.
Supplementary figure 1
Supplementary figure 1
See this image and copyright information in PMC

Comment in

  • Heart rate - A complex prognostic marker in acute heart failure.
    Olligs J, Linz D, Dechering DG, Eckardt L, Müller P. Olligs J, et al. Int J Cardiol Heart Vasc. 2019 Dec 28;26:100456. doi: 10.1016/j.ijcha.2019.100456. eCollection 2020 Feb. Int J Cardiol Heart Vasc. 2019. PMID: 32142076 Free PMC article. No abstract available.

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