Barywani Salim, Petzold Max
a Department of Molecular and Clinical Medicine/Cardiology , Sahlgrenska Academy, University of Gothenburg , Gothenburg , Sweden.
b Department of biostatistics , University of Gothenburg , Gothenburg , Sweden.
Scand Cardiovasc J. 2017 Aug;51(4):190-196. doi: 10.1080/14017431.2017.1314549. Epub 2017 Apr 10.
The present study aimed to investigate the impact of resting heart rate (HR) on 5-year all-cause mortality in patients ≥80 years with heart failure (HF) with reduced ejection fraction (HFrEF) and concomitant atrial fibrillation (AF) after optimal up-titration of beta-blockers (BBs).
Patients (n = 185) aged ≥80 years with HF and left ventricular ejection fraction ≤40% were included between January 2000 and January 2008 from two university hospitals, Sahlgrenska and Östra and retrospectively studied from January 2 to May 30, 2013. Up-titrations of guideline recommended medications were performed at HF outpatient clinics.
Of whole study population, 54% (n= 100) had AF. After optimal up-titration of BBs and angiotensin converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs), mean HR in patients with AF was 73 ± 15 beats/minute (bpm), 36% had resting HR ≤65 bpm. Five-year all-cause mortality among patients with AF was significantly lower in patients with HR ≤65 bpm (63%) compared to HR >65 (80%). Cox proportional-hazard regression analysis adjusted for clinically important baseline variables and doses of ACEIs/ARBs and BBs demonstrated resting HR ≤65 bpm as an independent predictor of improved survival compared to resting HR >65 bpm (HR 0.3, 95%CI 0.1-0.7, P 0.005).
In octogenarians with HFrEF and concomitant AF, lowering resting HR to levels as low as HR ≤65 bpm was still associated with improved survival from all-cause mortality. Our data indicate that mortality in AF became comparable to SR when patients were on maximally up-titrated beta-blocker doses with HR as low as 75 bpm.
本研究旨在探讨静息心率（HR）对年龄≥80岁、射血分数降低的心力衰竭（HFrEF）且合并心房颤动（AF）患者在β受体阻滞剂（BBs）优化上调滴定后5年全因死亡率的影响。
纳入2000年1月至2008年1月期间来自两家大学医院（萨尔格伦斯卡医院和东医院）的185例年龄≥80岁、患有HF且左心室射血分数≤40%的患者，并于2013年1月2日至5月30日进行回顾性研究。在HF门诊对指南推荐药物进行上调滴定。
在整个研究人群中，54%（n = 100）患有AF。在BBs和血管紧张素转换酶抑制剂（ACEIs）/血管紧张素受体阻滞剂（ARBs）优化上调滴定后，AF患者的平均HR为73±15次/分钟（bpm），36%的患者静息HR≤65 bpm。HR≤65 bpm的AF患者5年全因死亡率（63%）显著低于HR>65 bpm的患者（80%）。经临床重要基线变量以及ACEIs/ARBs和BBs剂量校正的Cox比例风险回归分析表明，与静息HR>65 bpm相比，静息HR≤65 bpm是生存改善的独立预测因素（HR 0.3，95%CI 0.1 - 0.7，P 0.005）。
在患有HFrEF且合并AF的八旬老人中，将静息HR降至低至HR≤65 bpm的水平仍与全因死亡率的生存改善相关。我们的数据表明，当患者使用最大上调滴定剂量的β受体阻滞剂且HR低至75 bpm时，AF患者的死亡率与窦性心律患者相当。
