Key result
Resting heart rate 80-99 bpm is linked to ~48% fewer CV events vs ≥100 in non-paroxysmal AF.
Why the study?
The prognostic significance of resting heart rate and its therapeutic target in atrial fibrillation are uncertain.
Does a resting heart rate of 68-99 bpm improve cardiovascular outcomes in patients with non-paroxysmal atrial fibrillation compared to higher or lower heart rates?
Cohort (n=3,217)
Yes
Does a resting heart rate of 68-99 bpm improve cardiovascular outcomes in patients with non-paroxysmal atrial fibrillation compared to higher or lower heart rates?
Effect estimate: HR 0.52 (95% CI 0.32-0.84)
Absolute Event Rate: 19.4% vs 37.8%
p-value: p=0.008
In patients with non-paroxysmal atrial fibrillation, a resting heart rate of 68-99 bpm is associated with a lower risk of adverse cardiovascular events compared to higher (≥100 bpm) or lower (≤59 bpm) heart rates.
May support 80-99 bpm targets in non-paroxysmal AF; hypothesis-generating and requires randomized confirmation.
The prognostic significance of resting heart rate and its therapeutic target in atrial fibrillation (AF) is uncertain. We sought to investigate the relationship between resting heart rate and cardiovascular outcomes in patients with non-paroxysmal AF (non-PAF). In this propensity score-weighted, multi-center prospective cohort study, 3217 patients with non-PAF were analyzed. Patients were categorized according to the baseline resting heart rate and cardiovascular outcomes were accessed for a median follow-up of 30 months. The primary outcome was a composite of cardiovascular death, heart failure hospitalization, and myocardial infarction/critical limb ischemia. Freedom from primary outcome was longest among patients with resting heart rate 80–99 beats per minute (bpm) whereas shortest among those with ≤ 59 bpm (weighted log rank, p = 0.008). Compared with heart rate ≥ 100 bpm, resting heart rate 80–99 and 60–79 bpm was associated with reduced risk of primary outcome (weighted hazard ratio [WHR] 0.52, 95% confidence interval [CI] 0.32–0.84, p = 0.008 and WHR 0.58, 95% CI 0.37–0.92, p = 0.021 for heart rate 80–99 and 60–79 bpm, respectively). Using weighted restricted cubic spline curves, there was a U-shaped association between the resting heart rate and primary outcome with reduced risk of primary outcome in heart rate range of 68–99 bpm. This association was maintained regardless of atrioventricular node (AVN) blocker use or persistent/permanent AF (p for interaction 0.767 for AVN blocker use and 0.720 for AF type). Resting heart rate was associated with cardiovascular outcomes in patients with non-PAF and those with resting heart rate between 68 and 99 bpm had lower risk of adverse cardiovascular events regardless of AVN blocker use or persistent/permanent AF.
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Park et al. (2023) conducted a cohort in Non-paroxysmal atrial fibrillation (n=3,217). Resting heart rate 80-99 bpm vs. Resting heart rate ≥ 100 bpm was evaluated on Composite of cardiovascular death, heart failure hospitalization, and myocardial infarction/critical limb ischemia (HR 0.52, 95% CI 0.32-0.84, p=0.008). A resting heart rate of 80-99 bpm was associated with a 48% reduced risk of adverse cardiovascular events (HR 0.52) compared to ≥100 bpm in patients with non-paroxysmal atrial fibrillation.
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