1st Chair and Depar tment of Cardiology, Medical University of Warsaw, Poland.
Unidad de Insuficiencia Car diaca Avanzada y Trasplante Cardiaco, Hospital Universitario A Cor una, CIBERCV, La Coruna, Spain.
Cardiol J. 2020;27(1):25-37. doi: 10.5603/CJ.a2018.0094. Epub 2018 Aug 29.
Currently, there is no information on whether in-hospital heart rate (HR) reduction has an influence on risk of death or rehospitalization. The study evaluates the relation between inhospital HR reduction in heart failure (HF) patients on mortality and rehospitalization within 1-year observation.
The analysis included patients hospitalized in Poland with sinus rhythm from the European Society of Cardiology Heart Failure Pilot (ESC-HF-Pilot) and ESC Heart Failure Long-Term Registries (ESC-HF-LT), who were divided into two groups: reduced HR and not-reduced HR. HR reduction was defined as a reduced value of HR at discharge compared to admission HR. The primary endpoint was 1-year all-cause death, the secondary endpoint was 1-year all-cause death or rehospitalization for worsening HF.
The final analysis included 747 patients; 491 reduced HR (65.7%) and 256 not-reduced HR (34.3%). The primary endpoint occurred in 58/476 (12.2%) from reduced HR group and in 26/246 (10.5%) from not-reduced HR group (p = 0.54). In the reduced HR group, independent predictors of primary endpoint were age, New York Heart Association class at admission, serum sodium level at admission and systolic blood pressure at discharge. In the not-reduced HR group the independent predictor of primary endpoint was diastolic blood pressure at discharge. The secondary endpoint was observed in 180 patients, 124/398 (31.2%) from reduced HR and 56/207 (27.1%) from the not-reduced HR group (p = 0.30). In the not-reduced HR group only angiotensin converting-enzyme inhibitor usage at discharge was independently associated with lower risk of the secondary endpoint.
In-hospital HR reduction did not influence on the outcomes of HF patients in sinus rhythm.
目前，尚无关于住院期间心率（HR）降低是否会影响死亡或再住院风险的信息。本研究评估了心力衰竭（HF）患者住院期间 HR 降低与 1 年观察期内死亡率和再住院率之间的关系。
该分析纳入了来自欧洲心脏病学会心力衰竭试点研究（ESC-HF-Pilot）和 ESC 心力衰竭长期注册研究（ESC-HF-LT）的波兰窦性节律住院患者，分为两组：HR 降低组和 HR 未降低组。HR 降低定义为出院时的 HR 值较入院时的 HR 值降低。主要终点为 1 年全因死亡，次要终点为 1 年全因死亡或因 HF 恶化而再住院。
最终分析纳入了 747 例患者；491 例 HR 降低（65.7%）和 256 例 HR 未降低（34.3%）。HR 降低组中，主要终点事件发生在 58/476 例（12.2%），HR 未降低组中发生在 26/246 例（10.5%）（p=0.54）。在 HR 降低组中，主要终点的独立预测因素为年龄、入院时纽约心脏协会（NYHA）心功能分级、入院时血清钠水平和出院时收缩压。在 HR 未降低组中，主要终点的独立预测因素为出院时舒张压。次要终点在 180 例患者中观察到，HR 降低组中 124/398 例（31.2%），HR 未降低组中 56/207 例（27.1%）（p=0.30）。在 HR 未降低组中，仅出院时使用血管紧张素转换酶抑制剂与较低的次要终点风险相关。
窦性节律 HF 患者住院期间 HR 降低对其结局无影响。
