Publication Date

2014

Abstract

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.

School/Institute

Mary MacKillop Institute for Health Research

Document Type

Journal Article

Access Rights

ERA Access

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