Holter-Derived Mean Heart Rate as a Predictor of Short-Term Clinical Risk in Patients Hospitalized With Acute Heart Failure

Background: Heart rate (HR) is a key marker of autonomic and hemodynamic stress in acute heart failure (AHF). Whether 24-h Holter-derived mean HR provides incremental prognostic value for short-term clinical outcomes during hospitalization remains unclear. This study evaluated the association between Holter-derived mean HR and short-term clinical outcomes in patients hospitalized with AHF. Methods: The study enrolled consecutive adults hospitalized with AHF at a tertiary hospital between October 2020 and June 2021. All participants underwent 24-h Holter monitoring during early hospitalization. Mean HR was categorized as < 70, 70–100, or > 100 beats per minute (bpm). Outcomes included in-hospital mortality, and all-cause mortality and readmission at 30, 60, and 90 days post-discharge. Two cardiologists blinded to outcomes interpreted Holter data. Statistical analyses were conducted to evaluate associations between mean HR categories and short-term clinical outcomes. Results: Ninety-four patients were included (mean age 66 ± 16.2 years; 56.4% female). In-hospital mortality was strongly associated with mean HR (4.8% for < 70 bpm vs. 31.3% for > 100 bpm; P = 0.023). A HR threshold > 100 bpm significantly increased in-hospital mortality (P = 0.012). In contrast, admission HR alone did not predict mortality (P = 0.573). Post-discharge mortality (1.1–4.3%) and readmission rates (5.3–13.8%) did not differ across HR categories. Conclusions: Holter-derived mean HR was a robust predictor of in-hospital mortality in patients hospitalized with AHF, outperforming single-time HR measurements. These findings may have potential relevance to perioperative risk assessment in patients with AHF, although prospective studies including surgical cohorts are required.