Key result
Low minimum heart rate linked to ~29% higher 30-day mortality in elderly HF patients.
Why the study?
Heart rate is a known predictor in heart failure, but its prognostic role in specific heart failure populations is diverse and not comprehensively identified.
Does a low minimum heart rate (< 60 bpm) predict higher all-cause mortality in elderly ICU patients with heart failure and hypertensive heart disease?
Cohort (n=2,476)
No
Does a low minimum heart rate (< 60 bpm) predict higher all-cause mortality in elderly ICU patients with heart failure and hypertensive heart disease?
Effect estimate: HR 1.289 (95% CI 1.044-1.591)
p-value: p=0.018
In elderly ICU patients with heart failure and hypertensive heart disease, a low minimum heart rate (<60 bpm) is associated with higher short- and long-term all-cause mortality compared to a higher minimum heart rate.
Low minimum heart rate should not yet prompt changes in care for elderly HF patients; leaves open its role as prognostic marker versus therapeutic target.
BACKGROUND: Heart rate has been documented as a predictive factor in heart failure. However, its prognostic role in specific heart failure patients is diverse and not comprehensively identified. METHODS: A retrospective cohort study was conducted based on the MIMIC-IV database. 2476 elderly (≥ 60 years old) patients with heart failure and hypertensive heart disease were recruited. The participants were divided into a low minimum heart rate (MHR) (< 60 bpm) group and a high MHR (≥ 60 bpm) group. Multivariable Cox proportional hazards regression analysis was implemented to evaluate the relationship between the two MHR groups and mortality. The association between prognosis and MHR as a continuous variable was elucidated via the restricted cubic spline model. The association in subgroups was assessed as well. RESULTS: Compared with high MHR, low MHR was significantly associated with higher 30-day all-cause mortalities (hazard ratio 1.289, 95% confidence interval 1.044 to 1.591, p = 0.018), 90-day all-cause mortality (hazard ratio 1.206, 95% confidence interval 1.007 to 1.444, p = 0.042), and 1-year all-cause mortality (hazard ratio 1.183, 95% confidence interval 1.016 to 1.377, p = 0.03) after adjustment for confounding variables. A U-shaped relationship between outcomes and MHR as a continuous variable was observed, with a nadir at MHR of approximately 50 to 60 bpm. The predictive value of low MHR was significant in women or without comorbidity, but not in men or with comorbidity. CONCLUSIONS: We demonstrated that MHR plays a prognostic role in elderly patients with heart failure and hypertensive heart disease. Low MHR predicts higher all-cause mortality, and the association conforms to a U-shaped pattern. Our findings extend those of previous studies and suggest the potential predictive value of HR in specific heart failure patients.
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Li et al. (2025) conducted a cohort in Heart failure and hypertensive heart disease (n=2,476). Low minimum heart rate (< 60 bpm) vs. High minimum heart rate (≥ 60 bpm) was evaluated on 30-day all-cause mortality (HR 1.289, 95% CI 1.044-1.591, p=0.018). Low minimum heart rate (< 60 bpm) was associated with a 29% higher risk of 30-day all-cause mortality (HR 1.289) compared to high minimum heart rate in elderly patients with heart failure.
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