What is the clinical evidence from this study?

Study design: Cohort. Population: Heart failure with reduced and preserved ejection fraction (n=2688). Intervention: Elevated baseline heart rate vs. Lower baseline heart rate. Primary outcome: All-cause mortality (HR 1.82, p=0.001).

December 31, 2013Open Access

Impact of Elevated Heart Rate on Clinical Outcomes in Patients with Heart Failure with Reduced and Preserved Ejection Fraction: A Report from the CHART-2 Study

Key Result

Elevated baseline heart rate was associated with increased all-cause mortality in both HFrEF (HR 1.77, P=0.008) and HFpEF (HR 1.82, P=0.001), and with increased cardiovascular death in HFpEF.

Study Design

Type

Cohort (n=2,688)

Structured PICO

Does elevated baseline heart rate increase mortality in patients with HFpEF compared to HFrEF?

Population

2,688 patients in Stage C or D heart failure with sinus rhythm from the CHART-2 registry.

Exposure

Elevated baseline heart rate (highest tertile)

Comparator

Lower baseline heart rate (lower tertiles)

Outcome

All-cause mortalityhard clinical

Elevated baseline heart rate is associated with increased all-cause mortality in both HFrEF and HFpEF, but specifically drives cardiovascular and heart failure death in HFpEF.

Main Result

Hazard Ratio: 1.82

p-value: p=0.001

Abstract

AIMS: It is still controversial whether elevated baseline heart rate (HR) is associated with higher mortality in patients with heart failure (HF) with preserved ejection fraction (HFpEF). We compared the impacts of baseline HR on mortality in patients with HFpEF and those with HF with reduced ejection fraction (HFrEF). METHODS AND RESULTS: We enrolled consecutive 2688 patients in Stage C or D HF with sinus rhythm from our Chronic Heart Failure Analysis and Registry in the Tohoku District 2 (CHART-2) Study (n = 10 219). The prognostic impact of HR increase was compared between the two groups, defined as left ventricular ejection fraction of 50% (HFpEF). Cox regression analysis revealed that elevated baseline HR was associated with increased all-cause mortality in both groups hazard ratio for the highest tertile (HH) 1.77 in HFrEF, P = 0.008; HH1.82 in HFpEF, P = 0.001. However, as for mode of death, elevated HR was associated with cardiovascular (CV) death in HFpEF (HH 2.17, P = 0.012), but the association was modest in HFrEF (HH1.49, P = 0.14): in particular, impact on HF death was different between HFpEF (HH 3.79, P = 0.020) and HFrEF (HH 1.07, P = 0.864). In contrast, the prognostic impact of baseline HR on non-CV death was noted only in patients with HFrEF. β-Blocker therapy was associated with reduced HF mortality in HFrEF (hazard ratio 0.49, P = 0.038) but not in HFpEF (hazard ratio 0.64, P = 0.321). CONCLUSIONS: Elevated HR was associated with increased CV death in HFpEF compared with HFrEF, although its impact on all-cause mortality was comparable between the two groups.