Author + information
- Masoor Kamalesh,
- Tarek Ajam,
- Samer Ajam and
- Srikant Devaraj
Background: Prior studies have shown short term (up to 1 year) increased adverse outcomes in heart failure with reduced ejection fraction (HFrEF) patients with higher heart rates (HR). We investigated long term effect of ambulatory HR on mortality in patients with HFrEF.
Methods: We queried the Veteran's Affairs databases to identify all patients diagnosed with HFrEF from 2007 to 2015 with EF <40%. Average HR was rounded to nearest 10th and mortality analyzed with HR equal to 60 to 100 beats per minute in increments of 10. Kaplan Meier survival curves were plotted for different HR. Cox Proportional Hazard models adjusting for patient characteristics, and 15 comorbidities were done. Mean follow up was 3.5 years.
Results: Using the sample of 113,505 observations, we found that higher the average HR corresponded to higher the mortality. From the Cox proportional hazard model, for every 10 beats per minute of heart rate, the hazard ratio without adjusting for patient characteristics is 1.2155 [95% CI: 1.2028-1.2283, p<0.001] and the hazard rate after adjusting for patient characteristics is 1.3011 [95% CI: 1.2858-1.3166, p<0.001]. The results were consistent for metoprolol and carvedilol sub-samples.
Conclusions: Our investigation extends prior observations that in patients with HFrEF, higher ambulatory HR predict higher long term mortality. Reducing HR may reduce mortality independent of other therapy
Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Emerging Developments in HFpEF and Arryhthmias
Abstract Category: 13. Heart Failure and Cardiomyopathies: Clinical
Presentation Number: 1250-289
- 2017 American College of Cardiology Foundation