Heart Rate Predicts Outcomes in an Implantable Cardioverter-Defibrillator Population

Ahmadi-Kashani, Mastaneh; Kessler, David J.; Day, John D.; Bunch, T. Jared; Stolen, Kira Q.; Brown, Scott A.; Sbaity, Salam; Olshansky, Brian

doi:10.1161/circulationaha.108.847608

Cited by 58 publications

(34 citation statements)

References 38 publications

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“…Autonomic imbalance resulting from sympathetic overactivity and parasympathetic withdrawal is likely to be the underlying mechanism of increased heart rate in HF [11]. Several pathophysiologic mechanisms, including increased myocardial oxygen consumption, reduced diastolic filling times, compromised coronary perfusion with induction of myocardial ischemia, and precipitation of rhythm disturbances have been proposed to explain the association between higher heart rate and worse outcomes in patients with HF [5,[12][13][14][15].…”

Section: Heart Rate and Outcome In Hfmentioning

confidence: 99%

Elevated heart rate at 24–36h after admission and in-hospital mortality in acute in non-arrhythmic heart failure

Lancellotti¹,

Ancion²,

Magné³

et al. 2015

International Journal of Cardiology

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Background: Elevated resting heart rate is associated with worse outcomes in chronic heart failure (HF) but little is known about its prognostic impact in acute setting. The main aim of the present study was to examine the relationship between resting heart rate obtained 24-36 h after admission for acute non-arrhythmic HF and inhospital mortality. Methods and results:We examined the association of heart rate with in-hospital mortality in a cohort of 712 patients admitted for acute HF. None of the patients had significant arrhythmias, required invasive ventilation, or presented with acute coronary syndrome or primary valvular disease. Forty patients (5.6%) died during the hospital stay. Those patients were significantly older (78 ± 9 vs. 72 ± 12 years; p = 0.0021), had higher heart rate (92 ± 22 vs. 78 ± 18 bpm; p b 0.0001), NT pro-BNP (p = 0.0005), creatinine (p = 0.023), were often diabetics (p = 0.026) and had lower systolic and diastolic blood pressures (p b 0.05). There was a significant graded relationship between the increase in mortality rate and tertile of heart rate (p b 0.01). With multivariable analysis, age (p = 0.037), heart rate (p b 0.0001), diastolic blood pressure (p b 0.001), prior ischemic heart disease (p = 0.02) and creatinine (p = 0.019) emerged as independent predictors of in-hospital mortality. After adjusting for predictors of poor prognosis, patients in the highest heart rate tertile had worst outcomes when compared with those in the lowest heart rate group (p = 0.007). Conclusions: Higher heart rate 24-36 h after admission for acute non-arrhythmic HF is associated with increased risk of in-hospital mortality. Early targeting of elevated heart rate might represent a complementary therapeutic challenge.

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Section: Heart Rate and Outcome In Hfmentioning

confidence: 99%

Elevated heart rate at 24–36h after admission and in-hospital mortality in acute in non-arrhythmic heart failure

Lancellotti¹,

Ancion²,

Magné³

et al. 2015

International Journal of Cardiology

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“…Several pathophysiological mechanisms, including increased myocardial oxygen consumption, reduced diastolic filling times, compromised coronary perfusion with induction of myocardial ischemia, and precipitation of rhythm disturbances have been proposed to explain this association 20, 21, 22…”

Section: Discussionmentioning

confidence: 99%

Serum albumin level and hospital mortality in acute non‐ischemic heart failure

et al. 2017

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AimsHypoalbuminemia is common in heart failure (HF), especially in elderly patients. It is associated with an increased risk of death. The present study sought to examine the prognostic significance of serum albumin level in the prediction of hospital mortality in patients admitted for acute non‐ischemic HF.Methods and resultsWe examined the association between albumin and hospital mortality in a cohort of 546 patients admitted for acute non‐ischemic HF. None of the patients had infectious disease, severe arrhythmias (atrial fibrillation, ventricular tachycardia, ventricular fibrillation), required invasive ventilation, or presented with acute coronary syndrome or primary valvular disease. Thirty‐six patients (7%) died during the hospital stay. These patients were significantly older (78 ± 9 vs. 72 ± 12 years; P = 0.006), had higher heart rate (P < 0.0001), increased creatinine level (P = 0.01), lower systolic and diastolic blood pressures (P < 0.05), elevated leucocyte count (P = 0.001), and lower albumin levels (31.3 ± 5.6 g/L vs. 36.9 ± 4.1 g/L; P < 0.001). With multivariable analysis, age (P = 0.01), heart rate (P < 0.0003), diastolic blood pressure (P < 0.01), leukocyte count (P = 0.009), and serum albumin level (P < 0.0001) emerged as independent predictors of hospital mortality. Hypoalbuminemia (<34 g/L) yielded the best sensitivity (78.8%) and specificity (75%) for predicting hospital death.ConclusionsSerum albumin level measured at admission can serve as a simple prognostic factor in acute non‐ischemic HF. Hypoalbuminemia is associated with increased risk of hospital mortality, especially in elderly patients.

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“…[31][32][33][34] On the other hand, a lot of clinical research focused on beta-blockers in chronic HF patients also suggested an association between the reduction in mortality and the magnitude of HR reduction. [35][36][37][38] Beta-blockers were only promising agents for HR reduction in HF patients.…”

Section: Discussionmentioning

confidence: 99%

Incidence and Predictors of Rehospitalization of Acute Heart Failure Patients

et al. 2015

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SummaryRepeated hospitalization due to acute decompensated heart failure (HF) is a pandemic health problem in Japan. However, it is difficult to predict rehospitalization after discharge for acute decompensated HF. We used a single hospital-based cohort from the Shinken Database 2004Database -2012 who visited the Cardiovascular Institute Hospital. A total of 282 patients discharged after their first acute HF admission were included in the analysis. The median follow-up period was 908 ± 865 days. Of these patients, rehospitalization due to worsening HF occurred in 55 patients. The cumulative rate of rehospitalization was 17.5% at 1 year, 21.4% at 2 years, and 25.5% at 3 years. Patients with rehospitalization were older than those without rehospitalization. Prevalence of diabetes mellitus (DM) was more common in patients with rehospitalization. Average heart rate (HR) tended to be higher in patients with rehospitalization. Loop diuretics were more commonly used at hospital discharge in patients with rehospitalization. Multivariate Cox regression analysis revealed that age ≥ 75 years, DM, HR ≥ 75 bpm at discharge, and use of loop diuretics at discharge were independent predictors for rehospitalization. The number of these independent risk factors could be used to clearly discriminate between the HF rehospitalization low-, middle-and high-risk patients. HF rehospitalization commonly occurred in patients who were discharged after their first acute HF admission. Older age, DM, increased HR, and loop diuretics use at discharge were independently associated with HF rehospitalization. By simply counting these risk factors, we might be able to predict the risk of HF rehospitalization after discharge. (Int Heart J 2015; 56: 219-225)

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Heart Rate Predicts Outcomes in an Implantable Cardioverter-Defibrillator Population

Cited by 58 publications

References 38 publications

Elevated heart rate at 24–36h after admission and in-hospital mortality in acute in non-arrhythmic heart failure

Elevated heart rate at 24–36h after admission and in-hospital mortality in acute in non-arrhythmic heart failure

Serum albumin level and hospital mortality in acute non‐ischemic heart failure

Incidence and Predictors of Rehospitalization of Acute Heart Failure Patients

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