Author + information
- Hanna Kim Gaggina,b,
- Alexander Turchina,b,
- Harshali Patela,b,
- Yang Songa,b,
- April Trebnicka,b,
- Gheorghe Dorosa,b,
- Nasrien Ibrahima,b,
- Juan Mayaa,b,
- Christopher Cannona,b and
- James Januzzia,b
Background: The relationship between real life heart rate (HR) reduction, guideline-directed medical therapy utilization (GDMT) and outcomes in heart failure (HF) with reduced ejection fraction (EF) is unclear.
Methods: Using electronic health records of the Partners Healthcare network, we identified chronic HFrEF (EF≤35%) patients in sinus rhythm who had available serial HR, visit and medication data (2000 – 2014).
Results: 4102 out of 6619 patients (62.0%) had HR ≥70 bpm at baseline, and compared to those with HR <70 bpm, were younger, more likely to be female and more likely to be on a lower median dose of beta blocker (BB, 50 vs. 75mg total daily metoprolol-equivalent dose, p<0.001). EF were similar. At baseline, 1013 (15.3%) had HR ≥70 bpm while on ≥50% of GDMT BB dose. At the end of follow up (38.8 months), 1255 (19.0%) still had HR ≥70 bpm despite receiving ≥50% of GDMT BB dose. In adjusted analyses, baseline HR was associated with incident mortality or HF hospitalization event rate (hazard ratio 1.23, p<0.001), all-cause mortality (hazard ratio 1.24, p<0.001) and HF hospitalization (hazard ratio 1.13, p<0.001) per 14.6 bpm increase. Patients with persistently high HR or increasing HR over follow up had the worst clinical outcomes while patients with persistently low HR or decreasing HR over follow up had better clinical outcomes.
Conclusions: In a large integrated network, elevated HR was common in HFrEF patients and associated with adverse outcomes. Opportunities exist to improve GDMT to achieve HR control.
Poster Hall, Hall C
Friday, March 17, 2017, 10:00 a.m.-10:45 a.m.
Session Title: Making Progress in Understanding Heart Failure
Abstract Category: 13. Heart Failure and Cardiomyopathies: Clinical
Presentation Number: 1123-273
- 2017 American College of Cardiology Foundation