Key result
Greater orthostatic HR increase in HF is linked to ~5% lower mortality or rehospitalization per bpm.
Why the study?
Orthostatic heart rate changes may reflect the extent of autonomic dysfunction and predict prognosis in patients with heart failure, but their prognostic association needed evaluation.
Does a greater orthostatic heart rate change predict improved prognosis (reduced all-cause mortality or HF rehospitalization) in patients with heart failure?
Observational (n=320)
No
Does a greater orthostatic heart rate change predict improved prognosis (reduced all-cause mortality or HF rehospitalization) in patients with heart failure?
Effect estimate: HR 0.954 (95% CI 0.925-0.985)
p-value: p=0.004
In patients with heart failure, a blunted heart rate increase upon standing from a supine position is an independent predictor of increased mortality and heart failure rehospitalization.
Blunted orthostatic HR response may identify higher-risk HF patients; hypothesis-generating and should not yet change practice.
BACKGROUND: Heart rate typically increases during postural changes from a supine to a standing position due to autonomic and hemodynamic factors. Changes in heart rate during orthostasis may reflect the extent of autonomic dysfunction in patients with heart failure (HF). Thus, orthostatic heart rate changes may be useful for evaluating autonomic function and may predict prognosis. This study examined the association between orthostatic heart rate changes and prognosis in patients with HF. METHODS AND RESULTS: We included 320 patients with HF in sinus rhythm (median age 70 years, 70.9% men) who were admitted to Kitasato University Hospital for HF treatment and whose heart rate was evaluated in the supine and upright positions during the stable period before discharge. We calculated heart rate changes based on supine and upright heart rate. We examined the association of orthostatic heart rate changes with patient prognosis (i.e., a composite of all-cause mortality or rehospitalization for HF). During the follow-up period (median 3.8 years; interquartile range 0.8-7.0 years), 129 events occurred. Orthostatic heart rate changes were associated with low composite event rates (log-rank P=0.015). After adjusting for potential confounders, increasing orthostatic heart rate changes were associated with decreased composite event rates (adjusted hazard ratio 0.954; 95% confidence interval 0.925-0.985; P=0.004). CONCLUSIONS: In patients with HF, poor orthostatic heart rate changes were associated with a worse prognosis.
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Sato et al. (2024) conducted an observational in Heart Failure (n=320). Orthostatic heart rate changes vs. Lower orthostatic heart rate changes was evaluated on Composite of all-cause mortality or rehospitalization for heart failure (HR 0.954, 95% CI 0.925-0.985, p=0.004). In patients with heart failure, increasing orthostatic heart rate changes were associated with a decreased risk of all-cause mortality or rehospitalization (HR 0.954 per 1-beat/min increase).
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