Key result
In-hospital heart rate reduction in AF-complicated AHF is linked to ~49% lower death or HF readmission.
Why the study?
Evidence linking in-hospital heart rate reduction to post-discharge outcomes among acute heart failure patients with atrial fibrillation is limited.
Does in-hospital heart rate reduction reduce the composite of all-cause death or heart failure readmission in acute heart failure survivors discharged in atrial fibrillation?
Cohort (n=182)
No
Does in-hospital heart rate reduction reduce the composite of all-cause death or heart failure readmission in acute heart failure survivors discharged in atrial fibrillation?
In acute heart failure patients discharged with atrial fibrillation, achieving an in-hospital reduction in heart rate is independently associated with a lower risk of post-discharge all-cause mortality or heart failure readmission.
May support targeting heart rate reduction in AHF with AF discharge; leaves open whether randomized trials confirm outcome benefit.
Background Evidence linking in-hospital heart rate (HR) reduction to post-discharge outcomes among acute heart failure (AHF) patients with atrial fibrillation (AF) is limited. Methods We analyzed a single-center registry of AHF survivors and restricted the cohort to patients in AF at discharge. HR reduction was defined as admission HR > discharge HR. The primary endpoint was a discharge-anchored composite of all-cause death or HF readmission. Cox proportional-hazards models adjusted for age, sex, eGFR, discharge systolic blood pressure, prior HF hospitalization, discharge ACE/ARB, and discharge beta-blocker. We also examined ΔHR as a continuous exposure (per 10 bpm). Kaplan–Meier curves with log-rank testing were generated. Results We studied 182 patients (134 primary events). HR reduction was associated with a lower risk of the primary composite (adjusted hazard ratio [HR] 0.51; 95% CI 0.34–0.76; p = 0.001). When ΔHR was modeled continuously, each 10-bpm reduction was associated with lower risk (HR 0.76; 95% CI 0.62–0.93; p = 0.007). Kaplan–Meier curves separated early and remained apart over follow-up (log-rank p < 0.01). Conclusions In AHF patients discharged in AF, in-hospital HR reduction was independently associated with fewer post-discharge events. Consistent findings across categorical and continuous exposure analyses support HR lowering as a pragmatic in-hospital management target for this population and warrant prospective confirmation.ESC2026
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Morinaga et al. (2026) conducted a cohort in Acute heart failure with atrial fibrillation at discharge (n=182). In-hospital heart rate reduction (admission HR > discharge HR) vs. No in-hospital heart rate reduction was evaluated on Discharge-anchored composite of all-cause death or heart failure readmission (HR 0.51, 95% CI 0.34-0.76, p=0.001). In-hospital heart rate reduction was associated with lower all-cause death or HF readmission in AHF patients discharged in AF (adjusted HR 0.51; 95% CI 0.34-0.76; p=0.001).
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