Heart Rate at Hospital Discharge in Patients With Heart Failure Is Associated With Mortality and Rehospitalization

Abstract

Background Whether heart rate upon discharge following hospitalization for heart failure is associated with long‐term adverse outcomes and whether this association differs between patients with sinus rhythm (SR) and atrial fibrillation (AF) have not been well studied. Methods and Results We conducted a retrospective cohort study from clinical registry data linked to Medicare claims for 46 217 patients participating in Get With The Guidelines ® –Heart Failure. Cox proportional‐hazards models were used to estimate the association between discharge heart rate and all‐cause mortality, all‐cause readmission, and the composite outcome of mortality/readmission through 1 year. For SR and AF patients with heart rate ≥75, the association between heart rate and mortality (expressed as hazard ratio [HR] per 10 beats‐per‐minute increment) was significant at 0 to 30 days (SR: HR 1.30, 95% CI 1.22 to 1.39; AF: HR 1.23, 95% CI 1.16 to 1.29) and 31 to 365 days (SR: HR 1.15, 95% CI 1.12 to 1.20; AF: HR 1.05, 95% CI 1.01 to 1.08). Similar associations between heart rate and all‐cause readmission and the composite outcome were obtained for SR and AF patients from 0 to 30 days but only in the composite outcome for SR patients over the longer term. The HR from 0 to 30 days exceeded that from 31 to 365 days for both SR and AF patients. At heart rates <75, an association was significant for mortality only for both SR and AF patients. Conclusions Among older patients hospitalized with heart failure, higher discharge heart rate was associated with increased risks of death and rehospitalization, with higher risk in the first 30 days and for SR compared with AF.

Prognostic Significance of Resting Heart Rate and Use of β-Blockers in Atrial Fibrillation and Sinus Rhythm in Patients With Heart Failure and Reduced Ejection Fraction

“…Furthermore, in contrast to the findings in patients with heart failure and SR, the association between discharge HR and all-cause readmission and the composite outcome (all-cause mortality or all-cause readmission) were not statistically significant, suggesting that in patients with AF, HR might be of lesser importance over the long term. 28 These support the notion that patients with HF and AF are at intrinsically higher risk for death, and this increased baseline risk attenuates an HR effect. However, it is noteworthy to mention that this study is different from our study because it included patients with both HFrEF and heart failure with preserved EF and only patients aged >65 years.…”

“…It might be that this intrinsically higher baseline risk explains the attenuation of the association for patients with AF at HRs <100 beats per minute. In a recently published study, 28 in patients with heart failure with concomitant AF, although early (0-30 days) and late (31-365 days) associations between HR and mortality were statistically significant at rates ≥75 beats per minute, the magnitude of this association decreased over the late term. Furthermore, in contrast to the findings in patients with heart failure and SR, the association between discharge HR and all-cause readmission and the composite outcome (all-cause mortality or all-cause readmission) were not statistically significant, suggesting that in patients with AF, HR might be of lesser importance over the long term.…”

Clinical Significance of Get With the Guidelines–Heart Failure Risk Score in Patients With Chronic Heart Failure After Hospitalization

“…The GWTG‐HF risk score consists of 7 commonly available clinical variables, and it can be used to establish the probability of in‐hospital mortality 15, 17. From the GWTG‐HF registry cohort, several studies have reported the risk of mortality and rehospitalization after discharge 24, 25, 26. There were no reports that revealed the significance of risk prediction beyond 1 year, and our present study demonstrated that the GWTG‐HF risk score could be a useful predictor for risk stratification for several years after discharge in patients with HF, both HFpEF or HFrEF.…”

Ivabradine

“…Observational cohorts and controlled trials have shown a consistent correlation between elevated HR and morbidity and mortality in general and HF with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF) specifically. [3][4][5][6][7][8][9][10][11] In the Get With The Guidelines-Heart Failure registry, resting HR ≥70 bpm in sinus rhythm on hospital admission was associated with increased in-hospital mortality, and resting HR on discharge predicted 1-year hospital readmission and mortality. 7,12 These data, however, do not distinguish whether HR is a risk factor or a modifiable therapeutic target.…”