Vol 27, No 1 (2020)
Original articles — Clinical cardiology
Published online: 2018-08-24

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In-hospital heart rate reduction and its relation to outcomes of heart failure patients with sinus rhythm: Results from the Polish part of the European Society of Cardiology Heart Failure Pilot and Long-Term Registries

Paweł Balsam1, Michał Peller1, Sonia Borodzicz1, Agnieszka Kapłon-Cieślicka1, Krzysztof Ozierański1, Agata Tymińska1, Michał Marchel1, Maria G. Crespo-Leiro2, Aldo Pietro Maggioni34, Jarosław Drożdż5, Marcin Grabowski1, Krzysztof J. Filipiak1, Grzegorz Opolski1
Pubmed: 30155862
Cardiol J 2020;27(1):25-37.

Abstract

Background: Currently, there is no information on whether in-hospital heart rate (HR) reduction has an influence on risk of death or rehospitalization. The study evaluates the relation between inhospital HR reduction in heart failure (HF) patients on mortality and rehospitalization within 1-year observation.

Methods: The analysis included patients hospitalized in Poland with sinus rhythm from the European Society of Cardiology Heart Failure Pilot (ESC-HF-Pilot) and ESC Heart Failure Long-Term Registries (ESC-HF-LT), who were divided into two groups: reduced HR and not-reduced HR. HR reduction was defined as a reduced value of HR at discharge compared to admission HR. The primary endpoint was 1-year all-cause death, the secondary endpoint was 1-year all-cause death or rehospitalization for worsening HF.

Results: The final analysis included 747 patients; 491 reduced HR (65.7%) and 256 not-reduced HR (34.3%). The primary endpoint occurred in 58/476 (12.2%) from reduced HR group and in 26/246 (10.5%) from not-reduced HR group (p = 0.54). In the reduced HR group, independent predictors of primary endpoint were age, New York Heart Association class at admission, serum sodium level at admission and systolic blood pressure at discharge. In the not-reduced HR group the independent predictor of primary endpoint was diastolic blood pressure at discharge. The secondary endpoint was observed in 180 patients, 124/398 (31.2%) from reduced HR and 56/207 (27.1%) from the not-reduced HR group (p = 0.30). In the not-reduced HR group only angiotensin converting-enzyme inhibitor usage at discharge was independently associated with lower risk of the secondary endpoint.

Conclusions: In-hospital HR reduction did not influence on the outcomes of HF patients in sinus rhythm.

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References

  1. Balsam P, Tymińska A, Kapłon-Cieślicka A, et al. Predictors of one-year outcome in patients hospitalised for heart failure: results from the Polish part of the Heart Failure Pilot Survey of the European Society of Cardiology. Kardiol Pol. 2016; 74(1): 9–17.
  2. Crespo-Leiro MG, Anker SD, Maggioni AP, et al. European Society of Cardiology Heart Failure Long-Term Registry (ESC-HF-LT): 1-year follow-up outcomes and differences across regions. Eur J Heart Failure. 2016; 18: 613–625.
  3. Ozierański K, Balsam P, Tymińska A, et al. Heart failure in elderly patients: differences in clinical characteristics and predictors of 1-year outcome in the Polish ESC-HF Long-Term Registry. Pol Arch Med Wewn. 2016; 126(7-8): 502–513.
  4. Kapłon-Cieślicka A, Tymińska A, Peller M, et al. Diagnosis, Clinical Course, and 1-Year Outcome in Patients Hospitalized for Heart Failure With Preserved Ejection Fraction (from the Polish Cohort of the European Society of Cardiology Heart Failure Long-Term Registry). Am J Cardiol. 2016; 118(4): 535–542.
  5. Kapłon-Cieślicka A, Balsam P, Ozierański K, et al. Resting heart rate at hospital admission and its relation to hospital outcome in patients with heart failure. Cardiol J. 2014; 21(4): 425–433.
  6. Targher G, Dauriz M, Laroche C, et al. ESC-HFA HF Long-Term Registry investigators. In-hospital and 1-year mortality associated with diabetes in patients with acute heart failure: results from the ESC-HFA Heart Failure Long-Term Registry. Eur J Heart Fail. 2017; 19(1): 54–65.
  7. Kannel WB, Kannel C, Paffenbarger RS, et al. Heart rate and cardiovascular mortality: the Framingham Study. Am Heart J. 1987; 113(6): 1489–1494.
  8. Kolloch R, Legler UF, Champion A, et al. Impact of resting heart rate on outcomes in hypertensive patients with coronary artery disease: findings from the INternational VErapamil-SR/trandolapril STudy (INVEST). Eur Heart J. 2008; 29(10): 1327–1334.
  9. Fox K, Ford I, Steg PG, et al. Heart rate as a prognostic risk factor in patients with coronary artery disease and left-ventricular systolic dysfunction (BEAUTIFUL): a subgroup analysis of a randomised controlled trial. Lancet. 2008; 372(9641): 817–821.
  10. Lechat P, Hulot JS, Escolano S, et al. Heart rate and cardiac rhythm relationships with bisoprolol benefit in chronic heart failure in CIBIS II Trial. Circulation. 2001; 103(10): 1428–1433.
  11. Pocock SJ, Wang D, Pfeffer MA, et al. Predictors of mortality and morbidity in patients with chronic heart failure. Eur Heart J. 2006; 27(1): 65–75.
  12. Laskey WK, Alomari I, Cox M, et al. Heart rate at hospital discharge in patients with heart failure is associated with mortality and rehospitalization. J Am Heart Assoc. 2015; 4(4).
  13. Maggioni AP, Dahlström U, Filippatos G, et al. Heart Failure Association of the European Society of Cardiology (HFA), Heart Failure Association of ESC (HFA). EURObservational Research Programme: the Heart Failure Pilot Survey (ESC-HF Pilot). Eur J Heart Fail. 2010; 12(10): 1076–1084.
  14. Maggioni AP, Dahlström U, Filippatos G, et al. EURObservational Research Programme: regional differences and 1-year follow-up results of the Heart Failure Pilot Survey (ESC-HF Pilot). Eur J Heart Fail. 2013; 15(7): 808–817.
  15. Ahmed A, Aronow WS, Fleg JL. Higher New York Heart Association classes and increased mortality and hospitalization in patients with heart failure and preserved left ventricular function. Am Heart J. 2006; 151(2): 444–450.
  16. Myftiu S, Bara P, Sharka I, et al. Heart failure predictors in a group of patients with myocardial infarction. Open Access Maced J Med Sci. 2016; 4(3): 435–438.
  17. Böhm M, Swedberg K, Komajda M, et al. Heart rate as a risk factor in chronic heart failure (SHIFT): the association between heart rate and outcomes in a randomised placebo-controlled trial. Lancet. 2010; 376(9744): 886–894.
  18. Greene SJ, Vaduganathan M, Wilcox JE, et al. The prognostic significance of heart rate in patients hospitalized for heart failure with reduced ejection fraction in sinus rhythm: insights from the EVEREST (Efficacy of Vasopressin Antagonism in Heart Failure: Outcome Study With Tolvaptan) trial. JACC Heart Fail. 2013; 1(6): 488–496.
  19. Kapoor JR, Heidenreich PA. Heart rate predicts mortality in patients with heart failure and preserved systolic function. J Card Fail. 2010; 16(10): 806–811.
  20. Bui AL, Grau-Sepulveda MV, Hernandez AF, et al. Admission heart rate and in-hospital outcomes in patients hospitalized for heart failure in sinus rhythm and in atrial fibrillation. Am Heart J. 2013; 165(4): 567–574.e6.
  21. Sato N, Gheorghiade M, Kajimoto K, et al. ATTEND Investigators. Hyponatremia and in-hospital mortality in patients admitted for heart failure (from the ATTEND registry). Am J Cardiol. 2013; 111(7): 1019–1025.
  22. Kajimoto K, Sato N, Keida T, et al. Low admission heart rate is a marker rather than a mediator of increased in-hospital mortality for patients with acute heart failure syndromes in sinus rhythm. Int J Cardiol. 2014; 171(1): 98–100.
  23. Lancellotti P, Ancion A, Magne J, et al. Elevated heart rate at 24-36h after admission and in-hospital mortality in acute in non-arrhythmic heart failure. Int J Cardiol. 2015; 182: 426–430.
  24. Habal MV, Liu PP, Austin PC, et al. Association of heart rate at hospital discharge with mortality and hospitalizations in patients with heart failure. Circ Heart Fail. 2014; 7(1): 12–20.
  25. Fox K, Ford I, Steg P, et al. Ivabradine for patients with stable coronary artery disease and left-ventricular systolic dysfunction (BEAUTIFUL): a randomised, double-blind, placebo-controlled trial. Lancet. 2008; 372(9641): 807–816.
  26. Li SJ, Sartipy U, Lund LH, et al. Prognostic Significance of Resting Heart Rate and Use of β-Blockers in Atrial Fibrillation and Sinus Rhythm in Patients With Heart Failure and Reduced Ejection Fraction: Findings From the Swedish Heart Failure Registry. Circ Heart Fail. 2015; 8(5): 871–879.