Key result
In HFREF patients, each 5 bpm increase in heart rate increased all-cause mortality risk in sinus rhythm (HR 1.06; 95% CI 1.01-1.11) but not in atrial fibrillation (P for interaction = 0.041).
Why the study?
Does higher baseline heart rate increase all-cause mortality in HFREF patients with atrial fibrillation compared to those with sinus rhythm?
Observational (n=2,539)
Does higher baseline heart rate increase all-cause mortality in HFREF patients with atrial fibrillation compared to those with sinus rhythm?
Hazard Ratio: 1.06 (95% CI 1.01–1.11)
p-value: p=0.012
In patients with HFrEF, higher baseline heart rate is associated with increased mortality in those with sinus rhythm, but not in those with atrial fibrillation.
Heart rate lacks prognostic value in HFREF with AF unlike sinus rhythm; challenges uniform targets and supports rhythm-specific outcome trials.
BACKGROUND: Heart rate has been associated with prognosis in patients with heart failure with reduced ejection fraction (HFREF) and sinus rhythm; whether this also holds true in patients with atrial fibrillation (AF) is unknown. HYPOTHESIS: To evaluate cardiac rhythm and baseline heart rate and the influence of outcome in patients with HFREF enrolled in the Cardiac Insufficiency Bisoprolol Study II. METHODS: In total, 2539 patients were stratified according to their baseline heart rhythm (AF or sinus rhythm) and into quartiles of heart rate (≤70 bpm, 71-78 bpm, 79-90 bpm, and >90 bpm). The primary outcome was all-cause mortality. Mean follow-up was 1.3 years. RESULTS: Mean age was 61 years, mean left ventricular ejection fraction was 28%, and 80% were male. A total of 521 (21%) patients had AF at baseline. The risk associated with all-cause mortality for each 5 bpm increase in heart rate in patients with sinus rhythm (hazard ratio [HR]: 1.06, 95% confidence interval [CI]: 1.01-1.11, P = 0.012) was significantly different from those with AF (HR: 1.00, 95% CI: 0.94-1.07, P = 0.90, P for interaction = 0.041). The risk associated with higher heart rate in sinus rhythm was primarily attributable to excess risk in the highest quartile (HR: 1.64, 95% CI: 1.18-2.30, P = 0.003). Allocation to bisoprolol did not modify the interaction between heart rate, rhythm and outcome. CONCLUSIONS: In HFREF patients with AF, a higher heart rate is not associated with increased event rates in contrast to HFREF patients with sinus rhythm.
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Mulder et al. (2017) conducted an observational in heart failure with reduced ejection fraction (HFREF) (n=2,539). Heart rate (per 5 bpm increase) was evaluated on all-cause mortality (HR 1.06, 95% CI 1.01-1.11, p=0.012). In HFREF patients, each 5 bpm increase in heart rate increased all-cause mortality risk in sinus rhythm (HR 1.06; 95% CI 1.01-1.11) but not in atrial fibrillation (P for interaction = 0.041).
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