Chronotropic Incompetence Predicts Reduced Survival and Exercise Capacity in Heart Failure: A Meta‐Analysis of Reconstructed Time‐to‐Event Data

Background The prognostic and functional significance of chronotropic incompetence (CI) across different heart failure (HF) phenotypes remains unclear in previous studies. Hypothesis This study compared survival and exercise performance in HF patients with and without CI. Methods We systematically searched PubMed, Embase, Scopus, and Cochrane Library until October 2025. Prognosis outcomes were assessed using Cox proportional hazards models based on reconstructed individual patient data. Exercise performance metrics were analyzed as mean differences (MD) using a random‐effects model. Restricted mean survival time analyses quantified differences in life expectancy. Results Twenty‐one studies were included. CI was associated with a higher risk of composite cardiovascular events (hazard ratio: 2.75; 95% CI: 2.18–3.48; p < 0.001) and all‐cause mortality (hazard ratio: 1.97; 95% CI: 1.64–2.36; p < 0.001). Over 2500‐days, patients with CI experienced 410 and 176 fewer event‐free days for composite cardiovascular events and all‐cause mortality, respectively. Patients with CI had significantly lower resting heart rate (HR) (MD: −6.25 bpm; p < 0.001), peak HR (MD: −35.12 bpm; p < 0.001), and HR reserve (MD: −28.84 bpm; p < 0.001). Moreover, the CI subgroup experienced lower exercise duration (MD: −77.68 s; p : 0.021), peak workload (MD: −19.15 watts; p < 0.001), and peak VO 2 (MD: −3.34 mL·kg −1 ·min −1 ; p < 0.001); with a higher VE/VCO 2 slope (MD: 2.20; p < 0.001). The results remained robust in both reduced and preserved HF phenotypes. Conclusion CI is associated with poorer survival and impaired functional capacity. These findings underscore the clinical importance of recognizing and addressing CI in the management of HF patients.