Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2021 Apr;8(1):e001606.
doi: 10.1136/openhrt-2021-001606.

Heart rate and adverse outcomes in patients with prevalent atrial fibrillation

Giorgio Moschovitis #  1   2 , Linda S B Johnson #  2   3 , Steffen Blum  4   5 , Stefanie Aeschbacher  4   5 , Maria Luisa De Perna  1 , Alberto Pagnamenta  6 , Patrizia Assunta Mayer Melchiorre  1 , Alexander P Benz  2 , Richard Kobza  7 , Marcello Di Valentino  8   9 , Christine S Zuern  4   5 , Angelo Auricchio  10 , Giulio Conte  10 , Nicolas Rodondi  11   12 , Manuel R Blum  11   12 , Juerg H Beer  13   14 , Michael Kühne  4   5 , Stefan Osswald  4   5 , David Conen  15 ; BEAT-AF and Swiss-AF investigators
Affiliations
Multicenter Study

Heart rate and adverse outcomes in patients with prevalent atrial fibrillation

Giorgio Moschovitis et al. Open Heart. 2021 Apr.

Abstract

Objective: The optimal target heart rate in patients with prevalent atrial fibrillation (AF) is not well defined. The aim of this study was to analyse the associations between heart rate and adverse outcomes in a large contemporary cohort of patients with prevalent AF.

Methods: From two prospective cohort studies, we included stable AF outpatients who were in AF on the baseline ECG. The main outcome events assessed during prospective follow-up were heart failure hospitalisation, stroke or systemic embolism and death. The associations between heart rate and adverse outcomes were evaluated using multivariable Cox regression models.

Results: The study population consisted of 1679 patients who had prevalent AF at baseline. Mean age was 74 years, and 24.6% were women. The mean heart rate on the baseline ECG was 78 (±19) beats per minute (bpm). The median follow-up was 3.9 years (IQR 2.2-5.0). Heart rate was not significantly associated with heart failure hospitalisation (adjusted HR (aHR) per 10 bpm increase, 1.00, 95% CI 0.94 to 1.07, p=0.95), stroke or systemic embolism (aHR 0.95, 95% CI 0.84 to 1.07, p=0.38) or death (aHR 1.02, 95% CI 0.95 to 1.09, p=0.66). There was no evidence of a threshold effect for heart rates <60 bpm or >100 bpm.

Conclusions: In this large contemporary cohort of outpatients with prevalent AF, we found no association between heart rate and adverse outcome events. These data are in line with recommendations that strict heart rate control is not needed in otherwise stable outpatients with AF.

Keywords: atrial fibrillation; heart failure; stroke.

PubMed Disclaimer

Conflict of interest statement

Competing interests: Disclosures/conflicts of interest outside of the submitted work, are reported within the manuscript. GM has received consultant fees for taking part to advisory boards from Novartis and Astra Zeneca outside of the submitted work. RK receives institutional grants from Abbott, Biosense-Webster, Boston-Scientific, Biotronik, Medtronic and Sis-Medical. CSZ reports a research grant from Medtronic and honoraria from Vifor Pharma and Novartis. AA has served as consultant to Boston Scientific, Backbeat, Biosense Webster, Cairdac, Corvia, Microport CRM, EPD-Philips and Radcliffe Publisher; he received speaker fees from Boston Scientific, Medtronic, and Microport; he participates in clinical trials sponsored by Boston Scientific, Medtronic, EPD-Philips; and he has intellectual properties with Boston Scientific, Biosense Webster, and Microport CRM. JHB reports grants from the Swiss National Foundation of Science, The Swiss Heart Foundation. MK has served on the speaker’s bureau for Boston Scientific, St. Jude Medical and Biotronik; he has received lecture/consulting fees from Sorin, Boehringer Ingelheim, Bayer, Sanofi Aventis, Novartis, Medtronic, Pfizer-BMS and has received unrestricted grants from Bayer and Pfizer-BMS; he is a proctor for Medtronic (Cryoballoon). DC has received consultant/speaker fees from Servier Canada and Roche Diagnostics, Switzerland, outside of the submitted work.

Similar articles

See all similar articles

Cited by

References

    1. Krijthe BP, Kunst A, Benjamin EJ, et al. . Projections on the number of individuals with atrial fibrillation in the European Union, from 2000 to 2060. Eur Heart J 2013;34:2746–51. 10.1093/eurheartj/eht280 - DOI - PMC - PubMed
    1. Wang TJ, Larson MG, Levy D, et al. . Temporal relations of atrial fibrillation and congestive heart failure and their joint influence on mortality: the Framingham heart study. Circulation 2003;107:2920–5. 10.1161/01.CIR.0000072767.89944.6E - DOI - PubMed
    1. Wolf PA, Mitchell JB, Baker CS, et al. . Impact of atrial fibrillation on mortality, stroke, and medical costs. Arch Intern Med 1998;158:229–34. 10.1001/archinte.158.3.229 - DOI - PubMed
    1. Conen D, Chae CU, Glynn RJ, et al. . Risk of death and cardiovascular events in initially healthy women with new-onset atrial fibrillation. JAMA 2011;305:2080–7. 10.1001/jama.2011.659 - DOI - PMC - PubMed
    1. Wyse DG, Waldo AL, DiMarco JP, et al. . A comparison of rate control and rhythm control in patients with atrial fibrillation. N Engl J Med 2002;347:1825–33. 10.1056/NEJMoa021328 - DOI - PubMed

Publication types