Prognostic Importance of Temporal Changes in Resting Heart Rate in Heart Failure Patients: An Analysis of the CHARM Program

Study Questions:

What is the relationship between changes in heart rate (HR) and outcomes in chronic heart failure patients?


This was an analysis derived from the 7,599 patients enrolled in the CHARM (Candesartan in Heart Failure Assessment of Reduction in Mortality and Morbidity) study. There were 14 trial visits at which resting HR was recorded and compared after 5 minutes of rest, by palpation for at least 30 seconds from auscultation of the heart or from electrocardiogram (ECG). Changes in HR from the preceding visit as well as the association between time updated HR and outcome were calculated and compared in Cox proportional hazards models.


The mean age of the cohort was 65 ± 11 years, and one third of the patients were female. An increase in HR from preceding visit was associated with a higher risk of all-cause mortality and the composite endpoint of cardiovascular death or hospitalization for HF (adjusted hazard ratio, 1.06; 95% confidence interval [CI], 1.05-1.08; p < 0.001, per 5 bpm higher HR), with lowering of HR being associated with lower risk, adjusting for covariates, including time-updated beta-blocker dose and baseline HR. Time-updated resting HR at each visit was also associated with risk (adjusted hazard ratio, 1.07; 95% CI, 1.06-1.09; p < 0.001, per 5 bpm higher HR).


Changes in HR over a period of time are associated with all-cause mortality, the composite endpoint of cardiovascular death or hospitalization for heart failure, and noncardiovascular outcomes.


HR may be useful for prognostic measures, and is easily measured to follow in the management of chronic heart failure patients. The changes in HR may be independent of medical management and uptitration of heart failure medications.

Clinical Topics: Dyslipidemia, Heart Failure and Cardiomyopathies, Prevention, Lipid Metabolism, Novel Agents, Acute Heart Failure, Smoking

Keywords: Auscultation, Benzimidazoles, Electrocardiography, Heart Failure, Heart Rate, Hospitalization, Palpation, Tetrazoles, Antihypertensive Agents, Blood Pressure, Body Mass Index, Smoking, Creatinine, Diabetes Mellitus, Germany, Calcinosis, Hemoglobin A, Lipoproteins, LDL, Obesity, Risk Factors

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