Lam Phillip H, Dooley Daniel J, Deedwania Prakash, Singh Steven N, Bhatt Deepak L, Morgan Charity J, Butler Javed, Mohammed Selma F, Wu Wen-Chih, Panjrath Gurusher, Zile Michael R, White Michel, Arundel Cherinne, Love Thomas E, Blackman Marc R, Allman Richard M, Aronow Wilbert S, Anker Stefan D, Fonarow Gregg C, Ahmed Ali
Center for Health and Aging, Veterans Affairs Medical Center, Washington, DC; Department of Medicine, Georgetown University, Washington, DC; Division of Cardiology, MedStar Washington Hospital Center, Washington, DC.
Center for Health and Aging, Veterans Affairs Medical Center, Washington, DC; Division of Cardiology, Department of Medicine, University of California, San Francisco, Fresno, California.
J Am Coll Cardiol. 2017 Oct 10;70(15):1861-1871. doi: 10.1016/j.jacc.2017.08.022.
A lower heart rate is associated with better outcomes in patients with heart failure (HF) with reduced ejection fraction (EF). Less is known about this association in patients with HF with preserved ejection fraction (HFpEF).
The aims of this study were to examine associations of discharge heart rate with outcomes in hospitalized patients with HFpEF.
Of the 8,873 hospitalized patients with HFpEF (EF ≥50%) in the Medicare-linked OPTIMIZE-HF (Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure) registry, 6,286 had a stable heart rate, defined as ≤20 beats/min variation between admission and discharge. Of these, 2,369 (38%) had a discharge heart rate of <70 beats/min. Propensity scores for discharge heart rate <70 beats/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 versus ≥70 beats/min, balanced on 58 baseline characteristics.
The 4,062 matched patients had a mean age of 79 ± 10 years, 66% were women, and 10% were African American. During 6 years (median 2.8 years) of follow-up, all-cause mortality was 65% versus 70% for matched patients with a discharge heart rate <70 versus ≥70 beats/min, respectively (hazard ratio [HR]: 0.86; 95% confidence interval [CI]: 0.80 to 0.93; p < 0.001). A heart rate <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% CI: 0.84 to 0.96; p = 0.002), but not with HF readmission (HR: 0.93; 95% CI: 0.85 to 1.01) or all-cause readmission (HR: 1.01; 95% CI: 0.95 to 1.08). Similar associations were observed regardless of heart rhythm or receipt of beta-blockers.
Among hospitalized patients with HFpEF, a lower discharge heart rate was independently associated with a lower risk of all-cause mortality, but not readmission.
射血分数降低的心力衰竭（HF）患者心率较低与较好的预后相关。而对于射血分数保留的心力衰竭（HFpEF）患者，这种关联的了解较少。
本研究旨在探讨住院HFpEF患者出院时心率与预后的关联。
在与医疗保险相关的OPTIMIZE-HF（住院心力衰竭患者启动挽救生命治疗的组织项目）登记处的8873例住院HFpEF患者（射血分数[EF]≥50%）中，6286例患者心率稳定，定义为入院和出院时心率变化≤20次/分钟。其中，2369例（38%）出院时心率<70次/分钟。对6286例患者中的每一例，估算出院时心率<70次/分钟的倾向评分，用于组建一个队列，其中2031对患者心率<70次/分钟与≥70次/分钟，在58项基线特征上达到平衡。
4062例匹配患者的平均年龄为79±10岁，66%为女性，10%为非裔美国人。在6年（中位时间2.8年）的随访中，出院时心率<70次/分钟与≥70次/分钟的匹配患者的全因死亡率分别为65%和70%（风险比[HR]：0.86；95%置信区间[CI]：0.80至0.93；P<0.001）。心率<70次/分钟还与HF再入院或全因死亡率的联合终点风险较低相关（HR：0.90；95%CI：0.84至0.96；P=0.002），但与HF再入院（HR：0.93；95%CI：0.85至1.01）或全因再入院（HR：1.01；95%CI：0.95至1.08）无关。无论心律或是否接受β受体阻滞剂治疗，均观察到类似的关联。
在住院HFpEF患者中，较低的出院心率与较低的全因死亡率风险独立相关，但与再入院无关。
