Prognostic Significance of Heart Rate and Beta-Blocker Use in Sinus Rhythm in Patients with Heart Failure and Preserved
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ORIGINAL ARTICLE
Prognostic Significance of Heart Rate and Beta‑Blocker Use in Sinus Rhythm in Patients with Heart Failure and Preserved Ejection Fraction Shijun Li1 · Xiaoying Li1 Received: 27 May 2019 / Accepted: 9 October 2019 © Italian Society of Hypertension 2019
Abstract Introduction Prognostic significance of heart rate (HR) in heart failure with preserved ejection fraction (HFpEF) remains poorly understood. Aim To evaluate the association of HR and beta-blocker use with all-cause mortality and the optimal HR range in patients with HFpEF and sinus rhythm (SR). Methods During a follow-up of 2.7 years (IQR 1.2–4.1 years), the 330 patients with median age 73 (IQR 64–79) years, 52.1% men, were included. HFpEF was defined as patients with EF ≥ 50%. The outcome measure was all-cause mortality. Results In total, 96 (29.1%) of patients with HFpEF and SR died. A linear tendency between HR and mortality was observed in SR. Compared to the reference strata HR ≤ 60 bpm, HR increment was associated with progressively increased risk in mortality (Chi-square = 13.90, Log rank P = 0.001) by Kaplan–Meier analyses. Univariate Cox regression showed that in SR, compared with that in HR 61–80 bpm, the unadjusted hazard ratios for mortality were 0.41 (95% CI 0.23–0.74, P = 0.003) in HR ≤ 60 bpm, 1.38 (95% CI 0.85–2.24, P = 0.189) in HR > 80 bpm. Multivariate Cox regression showed that compared with that in HR 61–80 bpm, the adjusted hazard ratios for mortality were 0.37 (95% CI 0.19–0.75, P = 0.005) in HR ≤ 60 bpm, 0.96 (95% CI 0.52–1.74, P = 0.899) in HR > 80 bpm. Univariate Cox regression showed that the unadjusted hazard ratios for mortality were 0.52 (95% CI 0.33–0.84, P = 0.003) in patients with beta-blocker as compared patients without beta-blocker. Multivariate Cox regression showed that the adjusted hazard ratios for mortality were 0.48 (95% CI 0.26–0.87, P = 0.016) in patients with beta-blocker as compared patients without beta-blocker. Conclusions HR is independently associated with increased all-cause mortality in SR and a lower HR (≤ 60 bpm) is favorable for better outcome in HFpEF patients with SR. Beta-blocker use is associated with reduced mortality and a lower HR is associated with reduced mortality in HFpEF patients with SR. Keywords Heart rate · Sinus rhythm · Beta-blocker · Heart failure · Preserved ejection fraction
1 Introduction The prognosis of heart failure with preserved ejection fraction (HFpEF) is poor [1, 2], since no effective therapeutic strategy to reduce adverse cardiac events has been developed. Many factors influencing heart failure (HF) outcomes have been identified but recent interest has mainly focused on heart rate (HR). Higher HR is associated with increased risk of cardiovascular death and or hospitalizations due to * Shijun Li [email protected] 1
Department of Geriatric Cardiology, Chinese PLA General Hospital, No. 28, Fuxing Road, Beijing 100853, People’s Republic of China
HF, and for every 1 beat per minutes (bpm) increase in HR in sinus rhythm (SR) the risk increase
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