Kim Young In, Ahn Min-Soo, Yoo Byung-Su, Kim Jang-Young, Son Jung-Woo, Park Young Jun, Kim Sung Hwa, Kang Dae Ryong, Lee Hae-Young, Kang Seok-Min, Cho Myeong-Chan
Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
Center of Biomedical Data Science, Yonsei University Wonju College of Medicine, Wonju, Korea.
Int J Heart Fail. 2024 Jul 3;6(3):119-126. doi: 10.36628/ijhf.2023.0052. eCollection 2024 Jul.
Beta-blockers (BBs) improve prognosis in heart failure (HF), which is mediated by lowering heart rate (HR). However, HR has no prognostic implication in atrial fibrillation (AF) and also BBs have not been shown to improve prognosis in heart failure with preserved ejection fraction (HFpEF) with AF. This study assessed the prognostic implication of BB in HFpEF with AF according to discharge HR.
From the Korean Acute Heart Failure Registry, 687 patients with HFpEF and AF were selected. Study subjects were divided into 4 groups based on 75 beats per minute (bpm) of HR at discharge and whether or not they were treated with BB at discharge.
Of the 687 patients with HFpEF and AF, 128 (36.1%) were in low HR group and 121 (36.4%) were in high HR group among those treated with BB at discharge. In high HR group, HR at discharge was significantly faster in BB non-users (85.5±9.1 bpm vs. 89.2±12.5 bpm, p=0.005). In the Cox model, BB did not improve 60-day rehospitalization (hazard ratio, 0.93; 95% confidence interval [95% CI], 0.35-2.47) or mortality (hazard ratio, 0.77; 95% CI, 0.22-2.74) in low HR group. However, in high HR group, BB treatment at discharge was associated with 82% reduced 60-day HF rehospitalization (hazard ratio, 0.18; 95% CI, 0.04-0.81), but not with mortality (hazard ratio, 0.77; 95% CI, 0.20-2.98).
In HFpEF with AF, in patients with HR over 75 bpm at discharge, BB treatment at discharge was associated with a reduced 60-day rehospitalization rate.
β受体阻滞剂（BBs）可改善心力衰竭（HF）的预后，这是通过降低心率（HR）来介导的。然而，心率对心房颤动（AF）并无预后意义，并且尚未证实BBs能改善伴有AF的射血分数保留的心力衰竭（HFpEF）的预后。本研究根据出院时心率评估BB在伴有AF的HFpEF中的预后意义。
从韩国急性心力衰竭登记处选取687例HFpEF合并AF的患者。研究对象根据出院时心率每分钟75次（bpm）以及出院时是否接受BB治疗分为4组。
在687例HFpEF合并AF的患者中，出院时接受BB治疗的患者中，128例（36.1%）属于低心率组，121例（36.4%）属于高心率组。在高心率组中，未使用BB的患者出院时心率明显更快（85.5±9.1 bpm对89.2±12.5 bpm，p = 0.005）。在Cox模型中，BB并未改善低心率组的60天再住院率（风险比，0.93；95%置信区间[95%CI]，0.35 - 2.47）或死亡率（风险比，0.77；95%CI，0.22 - 2.74）。然而，在高心率组中，出院时接受BB治疗与60天HF再住院率降低82%相关（风险比，0.18；95%CI，0.04 - 0.81），但与死亡率无关（风险比，0.77；95%CI，0.20 - 2.98）。
在伴有AF的HFpEF中，出院时心率超过75 bpm的患者，出院时接受BB治疗与60天再住院率降低相关。
