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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.

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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.

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