What is the clinical evidence from this study?

Study design: Cohort. Population: Heart failure (n=46217). Intervention: Higher discharge heart rate vs. Lower discharge heart rate. Primary outcome: All-cause mortality at 0 to 30 days for patients with sinus rhythm and heart rate ≥75 (per 10 beats-per-minute increment) (HR 1.30, 95% CI 1.22 to 1.39).

April 22, 2015Journal of the American Heart AssociationOpen Access

Heart Rate at Hospital Discharge in Patients With Heart Failure Is Associated With Mortality and Rehospitalization

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Key result

Higher discharge heart rate was associated with increased 30-day mortality in heart failure patients with sinus rhythm (HR 1.30; 95% CI 1.22-1.39 per 10 bpm increment) and atrial fibrillation.

Why the study?

Does higher discharge heart rate increase the risk of mortality and rehospitalization in older patients hospitalized with heart failure?

Key Points

To determine whether discharge heart rate after hospitalization for heart failure is associated with long-term adverse outcomes and whether this association differs between patients with sinus rhythm and atrial fibrillation.
Analyzed clinical registry data from Get With The Guidelines-Heart Failure linked to Medicare claims in a retrospective cohort of 46,217 patients.
Used Cox proportional-hazards models to assess associations between discharge heart rate and all-cause mortality, readmission, and composite outcomes through 1 year of follow-up.
For patients with discharge heart rate ≥75 bpm, each 10-bpm increase was significantly associated with higher 0-to-30-day mortality in sinus rhythm (HR 1.30, 95% CI 1.22–1.39) and atrial fibrillation (HR 1.23, 95% CI 1.16–1.29).
From 31 to 365 days, mortality risks per 10-bpm increment remained elevated for sinus rhythm (HR 1.15, 95% CI 1.12–1.20) and atrial fibrillation (HR 1.05, 95% CI 1.01–1.08), with higher hazard ratios observed in the first 30 days and among sinus rhythm patients.

Study Design

Type

Cohort (n=46,217)

Multicenter

Yes

Structured PICO

Does higher discharge heart rate increase the risk of mortality and rehospitalization in older patients hospitalized with heart failure?

Population

46,217 older patients hospitalized with heart failure from a clinical registry linked to Medicare claims, followed for up to 1 year.

Exposure

Discharge heart rate (exposure)

Comparator

Different heart rate strata (<75 vs ≥75 bpm) and rhythm (sinus rhythm vs atrial fibrillation)

Outcome

All-cause mortality, all-cause readmission, and the composite outcome of mortality/readmission through 1 yearhard clinical

Main Result

Hazard Ratio: 1.3 (95% CI 1.22–1.39)

Higher discharge heart rate in older patients hospitalized with heart failure is associated with increased risks of death and rehospitalization, particularly in the first 30 days and for those in sinus rhythm.

Implication

May inform short-term HF risk stratification; leaves open whether rate control improves outcomes.

Abstract

BACKGROUND: Whether heart rate upon discharge following hospitalization for heart failure is associated with long-term adverse outcomes and whether this association differs between patients with sinus rhythm (SR) and atrial fibrillation (AF) have not been well studied. METHODS AND RESULTS: We conducted a retrospective cohort study from clinical registry data linked to Medicare claims for 46 217 patients participating in Get With The Guidelines(®)-Heart Failure. Cox proportional-hazards models were used to estimate the association between discharge heart rate and all-cause mortality, all-cause readmission, and the composite outcome of mortality/readmission through 1 year. For SR and AF patients with heart rate ≥75, the association between heart rate and mortality (expressed as hazard ratio [HR] per 10 beats-per-minute increment) was significant at 0 to 30 days (SR: HR 1.30, 95% CI 1.22 to 1.39; AF: HR 1.23, 95% CI 1.16 to 1.29) and 31 to 365 days (SR: HR 1.15, 95% CI 1.12 to 1.20; AF: HR 1.05, 95% CI 1.01 to 1.08). Similar associations between heart rate and all-cause readmission and the composite outcome were obtained for SR and AF patients from 0 to 30 days but only in the composite outcome for SR patients over the longer term. The HR from 0 to 30 days exceeded that from 31 to 365 days for both SR and AF patients. At heart rates <75, an association was significant for mortality only for both SR and AF patients. CONCLUSIONS: Among older patients hospitalized with heart failure, higher discharge heart rate was associated with increased risks of death and rehospitalization, with higher risk in the first 30 days and for SR compared with AF.

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Cite This Study

Laskey et al. (2015) conducted a cohort in Heart failure (n=46,217). Higher discharge heart rate vs. Lower discharge heart rate was evaluated on All-cause mortality at 0 to 30 days for patients with sinus rhythm and heart rate ≥75 (per 10 beats-per-minute increment) (HR 1.30, 95% CI 1.22 to 1.39). Higher discharge heart rate was associated with increased 30-day mortality in heart failure patients with sinus rhythm (HR 1.30; 95% CI 1.22-1.39 per 10 bpm increment) and atrial fibrillation.

synapsesocial.com/papers/6a81a3b6bcfc941b47bf6530 https://doi.org/10.1161/jaha.114.001626