Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
Department of Cardiology, Nagoya Ekisaikai Hospital, Nagoya, Japan.
ESC Heart Fail. 2021 Aug;8(4):2982-2990. doi: 10.1002/ehf2.13388. Epub 2021 May 2.
Patients with acute heart failure (AHF) often present with an increased heart rate (HR), and the HR changes dramatically after initial treatment for AHF. However, the HR change after admission and the relationship between HR change in the early phase and prognosis have not been fully elucidated.
From a multicentre AHF registry, we retrospectively evaluated 1527 consecutive patients admitted with AHF. HR change (%) was calculated by [HR (at admission) - HR (24 h after admission)] × 100∕HR (at admission). The median HR change was 15.1% (range, 2.0-28.4%). The HR decreased most in the first 24 h and then gradually thereafter [admission: 98 (81-117) b.p.m., 24 h: 80 (70-92) b.p.m., 48 h: 78 (68-90) b.p.m., and 72 h: 77 (67-88) b.p.m.]. In Kaplan-Meier analysis, the cumulative event-free rates in the composite endpoint of death and rehospitalization due to AHF showed better according to larger HR change (P = 0.012, log rank). Cox proportional hazards analysis showed that HR change was a prognostic factor for composite endpoint adjusted by age and sex [hazard ratio, 0.995; 95% confidence interval (CI), 0.991-0.998; P = 0.006]. HR change was associated with outcome adjusted by age and sex in patients with sinus rhythm (hazard ratio, 0.993; 95% CI, 0.988-0.999; P = 0.015), but not in patients with atrial fibrillation (hazard ratio, 0.996; 95% CI, 0.990-1.002; P = 0.15).
A decrease in HR in the first 24 h after admission indicates better prognosis in patients with AHF, although the prognostic influence may differ between patients with sinus rhythm and those with atrial fibrillation.
急性心力衰竭（AHF）患者常伴有心率（HR）增加，且 AHF 初始治疗后 HR 变化显著。然而，入院后 HR 的变化以及早期 HR 变化与预后之间的关系尚未完全阐明。
我们从一项多中心 AHF 注册研究中回顾性评估了 1527 例连续入院的 AHF 患者。HR 变化（%）通过[入院时 HR（HR（at admission））-入院后 24 小时 HR（HR（24 h after admission））]×100∕HR（at admission）计算。中位 HR 变化为 15.1%（范围，2.0-28.4%）。HR 在最初 24 小时内下降最多，此后逐渐下降[入院时：98（81-117）次/分，24 小时时：80（70-92）次/分，48 小时时：78（68-90）次/分，72 小时时：77（67-88）次/分]。在 Kaplan-Meier 分析中，根据更大的 HR 变化，复合终点（死亡和因 AHF 再次住院）的累积无事件生存率更好（P=0.012，对数秩检验）。Cox 比例风险分析显示，HR 变化是调整年龄和性别后的复合终点的预后因素[风险比，0.995；95%置信区间（CI），0.991-0.998；P=0.006]。在窦性心律患者中，HR 变化与调整年龄和性别后的结局相关（风险比，0.993；95%CI，0.988-0.999；P=0.015），但在心房颤动患者中无相关性（风险比，0.996；95%CI，0.990-1.002；P=0.15）。
入院后 24 小时内 HR 下降表明 AHF 患者预后较好，尽管窦性心律患者和心房颤动患者的预后影响可能不同。
