Association of pulse rate with outcomes in heart failure with reduced ejection fraction: a retrospective cohort study

Abstract

Background: In a real-world setting, the effect of pulse rate measured at the time of diagnosis and serially during follow-up and management, on outcomes in heart failure with reduced ejection fraction (HFrEF), has not been wellstudied. Furthermore, how beta-blockade use in a real-world situation modifies this relation between pulse rate and outcomes in HFrEF is not well-known. Hence, we identified a large, national, real-world cohort of HFrEF to examine the association of pulse rate and outcomes. Methods: Using Veterans Affairs (VA) national electronic health records we identified incident HFrEF cases between 2006 and 2012. We examined the associations of both baseline and serially measured pulse rates, with mortality and days hospitalized per year for heart failure and for any cause, using crude and multivariable Cox proportional hazards and Poisson or negative binomial models, respectively. The exposure was examined as continuous, dichotomous, and categorical. Post-hoc analyses addressed the interaction of pulse rate and beta-blocker target dose. Results: We identified 51,194 incident HFrEF cases (67 ± 12 years, 98% male, 77% white. A significant positive, near linear relationship was observed for both baseline and serially measured pulse rates with all-cause mortality, allcause hospitalization and heart failure hospitalization after adjusting for covariates including beta-blocker use. Patients who had a pulse rate ≥ 70 bpm in the past 6 months had 36% (95% CI: 31-42%), 25% (95% CI: 19-32%), and 51% (95% CI: 33-72%) increased rates of mortality, all-cause hospitalization, and heart failure hospitalization, respectively, compared to patients with pulse rates < 70 bpm. A minority of subjects (15%) were treated with guideline directed beta blockade ≥50% of recommended target dose, among whom better outcomes were seen compared to those who did not achieve target dose in patients with pulse rates both above and below 70 beats per minute. Conclusions: High pulse rate, both at the time of diagnosis and during follow-up, is strongly associated with increased risk of adverse outcomes in HFrEF patients, independent of the use of beta-blockers. In a real-world setting, the majority of HFrEF patients do not achieve target dose of beta-blockade; greater use of strategies to reduce heart rate may improve outcomes in HFrEF.

Determinants of Pulse Rate change and Time-To Default from Treatment among Congestive Heart Failure Patients in Felege- Hiwot Referral Hospital, Bahir Dar, Ethiopia; comparison of separate and joint models

“…This means that if pushed out blood in the left ventricle in each heart beat increased by one percent, the average pulse rate of patients deceased by 11.10%. This nding is in line with other studies [7,11], which showed that LVEF were found to be negatively associated with the average evolution of pulse rate. However, our nding contradicts with the earlier study by Nesbitt, Doctorvaladan [17] which shows that no evidence of an association between left ventricular ejection fraction and quality of life of HF patients.…”

“…When the age of a patient increases by one year, the average pulse rate of patients is decreased by 8.88%, while all other predictors are held constant (P = 0.0040). This nding is in line with other studies [7,11,16], which showed that ages were found to be negatively associated with the average evolution of PR.…”

“…For a unit change in the true value of the repeated measure pulse rate, the relative change in the risk of defaulting is 1.0311 while other variables are kept constant. The results indicate that lower values of pulse rate are associated with better survival, which is in line with the ndings [11,16,23], higher resting heart rate was predictive of earlier mortality and heart rate reduction is associated with improved clinical outcomes in heart failure patients, which is in line with the ndings [11,16,23], higher resting heart rate is predictive of earlier mortality and heart rate reduction is associated with improved clinical outcomes in heart failure patients. This nding contrasts with the previous nding [24] which showed that a joint effect of both the mean number of abnormal heart rate (pulse rate) measurements and the risk of re-hospitalization were not statistically signi cant (p = 0.1650).…”

“…It proposes that a continued increment in heart rate increases the progression as well as the severity of the disease [10]. A greater heart rate measure is associated with a high risk of HF hospitalization and an inferior pulse rate measure at the base line and through follow-up time is positively related with minor risk of mortality and re-hospitalization [11].…”

Joint Modeling of Longitudinal Pulse Rate and Time-to-Default from Treatment of Congestive Heart Failure Patients

“…10 A greater heart rate measure is associated with a high risk of congestive heart failure (CHF) hospitalization and an inferior pulse rate measure at the base line and through follow-up time is positively related with minor risk of mortality and re-hospitalization. 11 Although the advancement in therapy and treatment of CHF is high, nowadays it is a chronic illness with an unpromising diagnosis, and has a high socioeconomic problem. 12 CHF is one of the major causes of hospitalization and high rates of mortality in several countries.…”