Heart rate and the risk of adverse outcomes in patients with heart failure with preserved ejection fraction

Background Although high resting heart rates are associated with adverse outcomes in heart failure with reduced ejection, the reports for heart failure with preserved ejection fraction (HFpEF) are conflicting. Design A secondary analysis was conducted in order to examine the relationship between resting heart rate and adverse outcomes in 2705 patients (mean age = 68 ± 10 years; 47% men; 88% white) with HFpEF who were in sinus rhythm from the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist Trial (TOPCAT). Methods Baseline heart rate was obtained from baseline electrocardiogram data. Outcomes were adjudicated by a clinical end-point committee and included the following factors: hospitalisation, hospitalisation for heart failure, death and cardiovascular death. Results Over a median follow-up of 3.4 years (25th-75th percentiles = 2.0-4.9 years), a total of 1157 hospitalisations, 311 hospitalizations for heart failure, 369 deaths and 233 cardiovascular deaths occurred. An increased risk (per 5-beats per minute bpm increase) for hospitalisation (hazard ratio HR = 1.03, 95% confidence interval CI = 1.004-1.060), hospitalisation for heart failure (HR = 1.10, 95% CI = 1.05-1.15), death (HR = 1.10, 95% CI = 1.06-1.16) and cardiovascular death (HR = 1.13, 95% CI = 1.07-1.19) was observed. When the analysis was limited to those who did not report the use of β-blockers, the magnitude of the association for each outcome (per 5-bpm increase) was not materially altered (hospitalisation: HR = 1.03, 95% CI = 0.97-1.09; hospitalisation for heart failure: HR = 1.12, 95% CI = 0.98-1.27; death: HR = 1.16, 95% CI = 1.05-1.28; cardiovascular death: HR = 1.12, 95% CI = 0.99-1.27). Conclusion High resting heart rate is a risk factor for adverse outcomes in patients with HFpEF, and future studies are needed in order to determine whether reducing heart rate improves outcomes in HFpEF.