心力衰竭合并心房颤动患者的出院心率与 1 年临床结局。

Discharge heart rate and 1-year clinical outcomes in heart failure patients with atrial fibrillation.

机构信息

Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510080, China.

National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing 100037, China.

出版信息

Chin Med J (Engl). 2022 Jan 5;135(1):52-62. doi: 10.1097/CM9.0000000000001768.

DOI:10.1097/CM9.0000000000001768

PMID:34982055

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8850821/

Abstract

BACKGROUND

The association between heart rate and 1-year clinical outcomes in heart failure (HF) patients with atrial fibrillation (AF), and whether this association depends on left ventricular ejection fraction (LVEF), are unclear. We investigated the relationship between discharge heart rate and 1-year clinical outcomes after discharge among hospitalized HF patients with AF, and further explored this association that differ by LVEF level.

METHODS

In this analysis, we enrolled 1760 hospitalized HF patients with AF from the China Patient-centered Evaluative Assessment of Cardiac Events Prospective Heart Failure study from August 2016 to May 2018. Patients were categorized into three groups with low (<65 beats per minute [bpm]), moderate (65-85 bpm), and high (≥86 bpm) heart rate measured at discharge. Cox proportional hazard models were employed to explore the association between heart rate and 1-year primary outcome, which was defined as a composite outcome of all-cause death and HF rehospitalization.

RESULTS

Among 1760 patients, 723 (41.1%) were women, the median age was 69 (interquartile range [IQR]: 60-77) years, median discharge heart rate was 75 (IQR: 69-84) bpm, and 934 (53.1%) had an LVEF <50%. During 1-year follow-up, a total of 792 (45.0%) individuals died or had at least one HF hospitalization. After adjusting for demographic characteristics, smoking status, medical history, anthropometric characteristics, and medications used at discharge, the groups with low (hazard ratio [HR]: 1.32, 95% confidence interval [CI]: 1.05-1.68, P = 0.020) and high (HR: 1.34, 95% CI: 1.07-1.67, P = 0.009) heart rate were associated with a higher risk of 1-year primary outcome compared with the moderate group. A significant interaction between discharge heart rate and LVEF for the primary outcome was observed (P for interaction was 0.045). Among the patients with LVEF ≥50%, only those with high heart rate were associated with a higher risk of primary outcome compared with the group with moderate heart rate (HR: 1.38, 95% CI: 1.01-1.89, P = 0.046), whereas there was no difference between the groups with low and moderate heart rate. Among the patients with LVEF <50%, only those with low heart rate were associated with a higher risk of primary outcome compared with the group with moderate heart rate (HR: 1.46, 95% CI: 1.09-1.96, P = 0.012), whereas there was no difference between the groups with high and moderate heart rate.

CONCLUSIONS

Among the overall HF patients with AF, both low (<65 bpm) and high (≥86 bpm) heart rates were associated with poorer outcomes as compared with moderate (65-85 bpm) heart rate. Among patients with LVEF ≥50%, only a high heart rate was associated with higher risk; while among those with LVEF <50%, only a low heart rate was associated with higher risk as compared with the group with moderate heart rate.

TRAIL REGISTRATION

Clinicaltrials.gov; NCT02878811.

摘要

背景

在伴有心房颤动（AF）的心力衰竭（HF）患者中，心率与 1 年临床结局之间的关系以及这种关系是否取决于左心室射血分数（LVEF）尚不清楚。我们研究了住院伴有 AF 的 HF 患者出院时的出院心率与 1 年临床结局之间的关系，并进一步探讨了这种与 LVEF 水平不同的关系。

方法

在这项分析中，我们纳入了 2016 年 8 月至 2018 年 5 月期间来自中国以患者为中心的评估心脏事件前瞻性心力衰竭研究的 1760 例住院伴有 AF 的 HF 患者。患者被分为三组，出院时的心率分别为低（<65 次/分钟[bpm]）、中（65-85 bpm）和高（≥86 bpm）。Cox 比例风险模型用于探讨心率与 1 年主要结局之间的关系，该结局定义为全因死亡和 HF 再住院的复合结局。

结果

在 1760 例患者中，723 例（41.1%）为女性，中位年龄为 69（四分位距[IQR]：60-77）岁，中位出院心率为 75（IQR：69-84）bpm，934 例（53.1%）的 LVEF <50%。在 1 年随访期间，共有 792 例（45.0%）患者死亡或至少有一次 HF 住院。在校正人口统计学特征、吸烟状况、既往病史、人体测量特征和出院时使用的药物后，低（风险比[HR]：1.32，95%置信区间[CI]：1.05-1.68，P=0.020）和高（HR：1.34，95% CI：1.07-1.67，P=0.009）心率组与 1 年主要结局的风险较高相关。主要结局的心率与 LVEF 之间存在显著的交互作用（P 交互=0.045）。在 LVEF≥50%的患者中，只有高心率组与中心率组相比，主要结局的风险更高（HR：1.38，95% CI：1.01-1.89，P=0.046），而低心率组与中心率组之间没有差异。在 LVEF <50%的患者中，只有低心率组与中心率组相比，主要结局的风险更高（HR：1.46，95% CI：1.09-1.96，P=0.012），而高心率组与中心率组之间没有差异。