- An elevated heart rate in sinus rhythm (SR) was an independent predictor of adverse cardiovascular outcomes in patients with heart failure and reduced ejection fraction (HFrEF), even after adjustment for N-terminal prohormone of B-type natriuretic peptide (NT-proBNP) concentration.
- No association was observed between heart rate and outcomes in atrial fibrillation (Afib).
Why this matters
- Existing analyses have not adjusted for natriuretic peptide concentration which is a single most powerful predictor of outcomes in HF and natriuretic peptide.
- Very little is known about how change in heart rate relates to outcomes in SR.
- Analysis of the PARADIGM-HF and ATMOSPHERE trials (n=13,562; patients with chronic, ambulatory HFrEF in both SR [n=10,113] and Afib [n=3449]).
- Heart rate was analysed as a categorical (tertiles, T1-3) and continuous variable (per 10 bpm) separately in patients with SR or Afib.
- Primary outcome: composite of time to first occurrence of cardiovascular death/HF hospitalisation.
- Funding: Novartis.
- Higher mean heart rate was noted in patients with Afib (79.9±17.2 bpm) than those with SR (70.1±13.1 bpm; P<.001>
- Increase in NT-proBNP concentrations were noted from the lowest to highest tertile of heart rates in patients with SR (P<.001>
- A lower heart rate was associated with better Kansas City Cardiomyopathy Questionnaire scores in both Afib and SR (P.001).
- Patients with SR showed greater risks (highest vs lowest heart rate tertiles) for:
- pump failure death: adjusted HR (aHR), 1.70; P<.001 and>
- sudden death: aHR, 1.28; P=.011.
- Retrospective analysis.