Bohm, M., Perez, A., Jhund, P. S, Reil, J. C, Komajda, M., Zile, M. R, McKelvie, R. S, Anand, I. S, Massie, B. M, Carson, P. E & McMurray, JJ. (2014). Relationship between heart rate and mortality and morbidity in the irbesartan patients with heart failure and preserved systolic function trial (I-Preserve). European Journal of Heart Failure,16(7), 778-787. United Kingdom: John Wiley and Sons Ltd. Retrieved from https://doi.org/10.1002/ejhf.85
Background: Higher heart rate is associated with poorer outcomes in patients with heart failure and reduced ejection fraction ( HF-REF ). Less is known about the association between heart rate and outcomes in patients with heart failure and preserved ejection fraction ( HF-PEF ). Therefore, we examined the relationship between heart rate and outcomes in the irbesartan in patients with heart failure and preserved systolic function trial ( I-Preserve ) in patients with an ejection fraction > 45% aged > 60 years. Methods and results: Heart rate was analysed as both a categorical ( tertiles ) and continuous variable. Patients in sinus rhythm ( n = 3271 ) and atrial fibrillation ( n = 696 ) were analysed separately. The outcomes examined were the primary endpoint of the trial ( all-cause death or cardiovascular hospitalization ), the composite of cardiovascular death or heart failure hospitalization ( and its components ) and all-cause death alone. Higher heart rate was associated with a significantly higher risk of all outcomes studied for patients in sinus rhythm, even after adjustment for other prognostic variables, including N-terminal pro-B-type natriuretic peptide. Each standard deviation ( 12.4 bpm ) increase in heart rate was associated with an increase in risk of 13% for cardiovascular death or heart failure hospitalization ( P = 0.002 ). No relationship between heart rate and outcomes was observed for patients in atrial fibrillation. Beta-blocker treatment did not reduce the heart rate–risk relationship. Conclusions: In patients with heart failure and preserved ejection fraction, heart rate is in sinus rhythm an independent predictor of adverse clinical outcomes and might be a therapeutic target in this syndrome.
Mary MacKillop Institute for Health Research
Access may be restricted.