Association between heart rate, metoprolol use, and clinical outcomes in patients with heart failure and chronic obstructive pulmonary disease

Elevated heart rate is a recognized prognostic marker in heart failure (HF), and beta‑blockers are recommended to control heart rate. However, real-world data on discharge heart rate, beta-blocker dosing, and their prognostic associations in patients with concomitant HF and chronic obstructive pulmonary disease (COPD) remain limited. We retrospectively analyzed data from patients with HF (left ventricular ejection fraction < 50%) and COPD. Patients were categorized by discharge heart rate as low (< 70 beats/min) or high (≥ 70 beats/min). Kaplan–Meier and Cox regression analyses were used to estimate associations with three‑year all‑cause mortality. Subgroup analyses were performed by HF phenotype, rhythm, and COPD status. Among 611 patients (204 with low heart rate, 407 with high heart rate), those with high heart rate had significantly higher all‑cause mortality (log-rank p < 0.001). After multivariable adjustment, high heart rate remained independently associated with increased mortality (HR 1.86; 95%CI 1.22–2.84; p = 0.004). Higher metoprolol dose was associated with lower mortality (HR 0.80; 95%CI 0.69–0.92; p = 0.002). These associations were consistent across all subgroups, with no significant interactions (all interaction p > 0.05). In patients with HF and COPD, elevated discharge heart rate was associated with higher all-cause mortality, and higher metoprolol dose was associated with better survival. However, given the observational design, these associations likely reflect underlying disease severity and treatment tolerance. Discharge heart rate may serve as an integrative risk marker. Randomized trials are warranted.