Author + information
- Received July 10, 2017
- Revision received August 9, 2017
- Accepted August 9, 2017
- Published online October 2, 2017.
- Phillip H. Lam, MDa,b,c,
- Daniel J. Dooley, MDa,b,c,
- Prakash Deedwania, MDa,d,
- Steven N. Singh, MDb,e,
- Deepak L. Bhatt, MD, MPHf,g,
- Charity J. Morgan, PhDh,
- Javed Butler, MD, MPH, MBAi,
- Selma F. Mohammed, MD, PhDc,
- Wen-Chih Wu, MDj,k,
- Gurusher Panjrath, MDl,
- Michael R. Zile, MDm,n,
- Michel White, MDo,
- Cherinne Arundel, MDb,l,p,
- Thomas E. Love, PhDq,
- Marc R. Blackman, MDa,b,l,
- Richard M. Allman, MDr,
- Wilbert S. Aronow, MDs,t,
- Stefan D. Anker, MD, PhDu,v,
- Gregg C. Fonarow, MDw and
- Ali Ahmed, MD, MPHa,l,x,∗ ()
- aCenter for Health and Aging, Veterans Affairs Medical Center, Washington, DC
- bDepartment of Medicine, Georgetown University, Washington, DC
- cDivision of Cardiology, MedStar Washington Hospital Center, Washington, DC
- dDivision of Cardiology, Department of Medicine, University of California, San Francisco, Fresno, California
- eSection of Cardiology, Department of Medicine, Veterans Affairs Medical Center, Washington, DC
- fDepartment of Medicine, Brigham and Women's Hospital Heart & Vascular Center, Boston, Massachusetts
- gHarvard Medical School, Boston, Massachusetts
- hDepartment of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
- iDivision of Cardiology, Department of Medicine, Stony Brook University, Stony Brook, New York
- jSection of Cardiology, Department of Medicine, Veterans Affairs Medical Center, Providence, Rhode Island
- kDivision of Cardiology, Department of Medicine, Brown University, Providence, Rhode Island
- lDepartment of Medicine, George Washington University, Washington, DC
- mSection of Cardiology, Department of Medicine, Ralph H. Johnson VA Medical Center, Charleston, South Carolina
- nDivision of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
- oDivision of Cardiology, Montreal Heart Institute, Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
- pHospitalist Section, Medical Service Department, Veterans Affairs Medical Center, Washington, DC
- qDepartment of Medicine, Department of Population and Quantitative Health Sciences, and Center for Health Care Research and Policy, Case Western Reserve University, Cleveland, Ohio
- rGeriatrics and Extended Care, Department of Veterans Affairs, Washington, DC
- sDivision of Cardiology, Department of Medicine, Westchester Medical Center, Valhalla, New York
- tDivision of Cardiology, Department of Medicine, New York Medical College, Valhalla, New York
- uDivision of Cardiology and Metabolism–Heart Failure, Cachexia & Sarcopenia, Department of Cardiology (CVK), Berlin-Brandenburg Center for Regenerative Therapies (BCRT), and Deutsches Zentrum für Herz-Kreislauf-Forschung (German Centre for Cardiovascular Research), Charité–Universitätsmedizin Berlin, Berlin, Germany
- vDepartment of Cardiology and Pneumology, University Medicine Göttingen, Göttingen, Germany
- wDivision of Cardiology, Department of Medicine, University of California, Los Angeles, Los Angeles, California
- xDivision of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
- ↵∗Address for correspondence:
Dr. Ali Ahmed, Center for Health and Aging (1D 129D), Washington DC VA Medical Center, 50 Irving Street NW, Washington, DC 20422.
Background A lower heart rate is associated with better outcomes in patients with heart failure (HF) with reduced ejection fraction (EF). Less is known about this association in patients with HF with preserved ejection fraction (HFpEF).
Objectives The aims of this study were to examine associations of discharge heart rate with outcomes in hospitalized patients with HFpEF.
Methods Of the 8,873 hospitalized patients with HFpEF (EF ≥50%) in the Medicare-linked OPTIMIZE-HF (Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure) registry, 6,286 had a stable heart rate, defined as ≤20 beats/min variation between admission and discharge. Of these, 2,369 (38%) had a discharge heart rate of <70 beats/min. Propensity scores for discharge heart rate <70 beats/min, estimated for each of the 6,286 patients, were used to assemble a cohort of 2,031 pairs of patients with heart rate <70 versus ≥70 beats/min, balanced on 58 baseline characteristics.
Results The 4,062 matched patients had a mean age of 79 ± 10 years, 66% were women, and 10% were African American. During 6 years (median 2.8 years) of follow-up, all-cause mortality was 65% versus 70% for matched patients with a discharge heart rate <70 versus ≥70 beats/min, respectively (hazard ratio [HR]: 0.86; 95% confidence interval [CI]: 0.80 to 0.93; p < 0.001). A heart rate <70 beats/min was also associated with a lower risk for the combined endpoint of HF readmission or all-cause mortality (HR: 0.90; 95% CI: 0.84 to 0.96; p = 0.002), but not with HF readmission (HR: 0.93; 95% CI: 0.85 to 1.01) or all-cause readmission (HR: 1.01; 95% CI: 0.95 to 1.08). Similar associations were observed regardless of heart rhythm or receipt of beta-blockers.
Conclusions Among hospitalized patients with HFpEF, a lower discharge heart rate was independently associated with a lower risk of all-cause mortality, but not readmission.
Dr. Ahmed was supported in part by the National Institutes of Health through grants R01-HL085561, R01-HL085561-S, and R01-HL097047) from the National Heart, Lung, and Blood Institute. Dr. Bhatt has served on the advisory boards of Cardax, Elsevier Practice Update Cardiology, Medscape Cardiology, and Regado Biosciences; has served on the board of directors of the Boston VA Research Institute and the Society of Cardiovascular Patient Care; served as chair of the American Heart Association Quality Oversight Committee; has served on data monitoring committees for the Cleveland Clinic, Duke Clinical Research Institute, Harvard Clinical Research Institute, Mayo Clinic, Mount Sinai School of Medicine, and Population Health Research Institute; has received honoraria from the American College of Cardiology (senior associate editor, Clinical Trials and News, ACC.org), Belvoir Publications (Editor-in-Chief, Harvard Heart Letter), Duke Clinical Research Institute (clinical trial steering committees), Harvard Clinical Research Institute (clinical trial steering committee), HMP Communications (Editor-in-Chief, Journal of Invasive Cardiology), Journal of the American College of Cardiology (guest editor; associate editor), Population Health Research Institute (clinical trial steering committee), Slack Publications (chief medical editor, Cardiology Today’s Intervention), Society of Cardiovascular Patient Care (secretary/treasurer), and WebMD (CME steering committees); has other relationships with Clinical Cardiology (deputy editor), NCDR-ACTION Registry Steering Committee (chair), and VA CART Research and Publications Committee (chair); has received research funding from Amarin, Amgen, AstraZeneca, Bristol-Myers Squibb, Chiesi, Eisai, Ethicon, Forest Laboratories, Ironwood, Ischemix, Lilly, Medtronic, Pfizer, Roche, Sanofi, and The Medicines Company; has received royalties from Elsevier (editor, Cardiovascular Intervention: A Companion to Braunwald’s Heart Disease); has been a site coinvestigator for Biotronik, Boston Scientific, and St. Jude Medical (now Abbott); has been a trustee for the American College of Cardiology; and has performed unfunded research for FlowCo, Merck, PLx Pharma, and Takeda. Dr. Butler is a consultant to Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, CVRx, Janssen, Luitpold, Medtronic, Novartis, Relypsa, Roche, Vifor, and ZS Pharma. Dr. Panjrath has been a speaker for Amgen. Dr. Anker has served as a consultant to Servier, Novartis, St. Jude Medical, Bayer, Boehringer Ingelheim, and Vifor. Dr. Fonarow has been a consultant for Amgen, Novartis, Medtronic, and St. Jude Medical; and served as principle investigator for OPTIMIZE-HF, which was sponsored by GlaxoSmithKline. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Drs. Lam and Dooley contributed equally to this work.
- Received July 10, 2017.
- Revision received August 9, 2017.
- Accepted August 9, 2017.