Lower Heart Rate Associated with Lower All-Cause Mortality Risk in HFpEF

Among older hospitalized patients with heart failure with preserved ejection fraction (HFpEF), a lower heart rate at discharge is associated with a lower risk of all-cause mortality, but not with lower HF-related or all-cause readmission, according to a study published Oct. 2 in the Journal of the American College of Cardiology.

Using data from the Medicare-linked OPTIMIZE-HF study, Phillip H. Lam, MD, et al., examined the associations of discharge heart rate with outcomes in 8,873 hospitalized patients with HFpEF. Out of 6,286 of those patients with a stable heart rate, 2,369 (38 percent) had a discharge heart rate of <70 beats/min.

Propensity scores for discharge heart rate <70 beats per min, estimated for each of the 6,286 patients, were used to assemble a cohort of 2,031 pairs of patients with heart rate <70 vs. ≥70 beats/min, balanced on key measured baseline characteristics. A total of 4,062 patients were matched, with a mean age of 79 ± 10 years, ejection fraction of 59 ± 7 percent and discharge heart rate of 71 ± 12 beats/min. The matches were 66 percent women and 10 percent African American.

Results in the present study showed during a six-year follow-up, all-cause mortality for matched patients was 65 percent for those with a discharge heart rate <70 beats/min vs. 70 percent for those with ≥70 beats/min, respectively (hazard ratio [HR], 0.86; 95 percent confidence interval [CI], 0.80-0.93).

A heart rate of <70 beats/min was also associated with a lower risk for the combined endpoint of HF readmission or all-cause mortality (HR, 0.90; 95 percent CI, 0.84-0.96), but not with HF readmission (HR, 0.93; 95 percent CI, 0.85-1.01) or all-cause readmission (HR, 1.01; 95 percent CI, 0.95-1.08).

Subgroup analyses demonstrated that the beneficial association between heart rate <70 beats/min and all-cause mortality was similar across various clinically relevant subgroups of patients, including those by baseline atrial fibrillation and beta-blocker use.

“These findings suggest that the beneficial association of a lower heart rate and improved survival observed in patients with HFrEF [HF with reduced ejection fraction] might extend to those with HFpEF,” the study authors write. “Future studies are needed to develop and test interventions that might improve outcomes in patients with HFpEF and elevated heart rate.”

In an accompanying editorial comment, Daniel E. Forman, MD, FACC, and Dae Hyun Kim, MD, MPH, SCD, note that the study “raises important considerations about the merits of lower heart rates, but pertinent geriatric implications should also be considered.” They add, “The field of geriatric cardiology has come of age, and it fundamentally demands that broader patient-centered perspectives be integrated with disease-based principles. These are essential steps toward increasing the overall value of therapies that must ultimately address clinical challenges that are as much about multifaceted patient complexity as they are about cardiovascular pathophysiology.”

Clinical Topics: Geriatric Cardiology, Heart Failure and Cardiomyopathies, Acute Heart Failure

Keywords: Heart Rate, Stroke Volume, Patient Readmission, African Americans, Follow-Up Studies, Propensity Score, Adrenergic beta-Antagonists, Heart Failure, Medicare, Patient Discharge, Geriatrics, Heart Failure

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