Key result
High resting heart rate (≥75 bpm) and low systolic blood pressure (<110 mmHg) were associated with increased risk of cardiovascular death and HF hospitalization (HR 1.83; 95% CI 1.51-2.21; p<0.001).
Why the study?
High resting heart rate and low systolic blood pressure are a risk factor and risk indicator for poor heart failure outcomes, prompting evaluation of their associations with outcomes and treatment patterns in HFrEF.
Does the combination of baseline resting heart rate and systolic blood pressure predict cardiovascular outcomes in patients with HFrEF?
Observational (n=7,317)
Yes
Does the combination of baseline resting heart rate and systolic blood pressure predict cardiovascular outcomes in patients with HFrEF?
Hazard Ratio: 1.83 (95% CI 1.51–2.21)
p-value: p=< 0.001
In HFrEF patients with recent hospitalization, the combination of elevated resting heart rate and lower systolic blood pressure identifies those at highest risk for cardiovascular events.
AIMS: A high resting heart rate (RHR) and low systolic blood pressure (SBP) are a risk factor and a risk indicator, respectively, for poor heart failure (HF) outcomes. This analysis evaluated the associations between baseline RHR and SBP with outcomes and treatment patterns in patients with HF and reduced ejection fraction (HFrEF) in the QUALIFY (QUality of Adherence to guideline recommendations for LIFe-saving treatment in heart failure surveY) international registry. METHODS AND RESULTS: Between September 2013 and December 2014, 7317 HFrEF patients with a previous HF hospitalization within 1-15 months were enrolled in the QUALIFY registry. Complete follow-up data were available for 5138 patients. The relationships between RHR and SBP and outcomes were assessed using a Cox proportional hazards model and were analysed according to baseline values as high RHR (H-RHR) ≥75 bpm versus low RHR (L-RHR) <75 bpm and high SBP (H-SBP) ≥110 mmHg versus low SBP (L-SBP) <110 mmHg and analysed according to each of the following four phenotypes: H-RHR/L-SBP, L-RHR/L-SBP, H-RHR/H-SBP and L-RHR/H-SBP (reference group). Compared to the reference group, H-RHR/L-SBP was associated with the worst outcomes for the combined primary endpoint of cardiovascular death and HF hospitalization (hazard ratio [HR] 1.83, 95% confidence interval [CI] 1.51-2.21, p < 0.001), cardiovascular death (HR 2.70, 95% CI 1.69-4.33, p < 0.001), and HF hospitalization (HR 1.62, 95% CI 1.30-2.01, p < 0.001). Low-risk patients with L-RHR/H-SBP achieved more frequently ≥50% of target doses of angiotensin-converting enzyme inhibitors (ACEIs) and beta-blockers (BBs) than the other groups. However, 48% and 46% of low-risk patients were not well treated with ACEIs and BBs, respectively (≤50% of target dose or no treatment). CONCLUSION: In patients with HFrEF and recent hospitalization, elevated RHR and lower SBP identify patients at increased risk for cardiovascular endpoints. While SBP and RHR are often recognized as barriers that deter physicians from treating with high doses of recommended drugs, they are not the only reason leaving many patients suboptimally treated.
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Abdin et al. (2023) conducted an observational in Heart failure with reduced ejection fraction (HFrEF) (n=7,317). High resting heart rate (≥75 bpm) and low systolic blood pressure (<110 mmHg) vs. Low resting heart rate (<75 bpm) and high systolic blood pressure (≥110 mmHg) was evaluated on Combined primary endpoint of cardiovascular death and HF hospitalization (HR 1.83, 95% CI 1.51-2.21, p=< 0.001). High resting heart rate (≥75 bpm) and low systolic blood pressure (<110 mmHg) were associated with increased risk of cardiovascular death and HF hospitalization (HR 1.83; 95% CI 1.51-2.21; p<0.001).
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