Mody Freny Vaghaiwalla, Goyal Ravi K, Ajmera Mayank, Davis Keith L, Amin Alpesh N
Division of Cardiology 111E, Department of Medicine, Veterans Affairs Greater Los Angeles HCS, and the Department of Medicine at Ronald, Reagan University of California Medical Center, Los Angeles (UCLA) at the David Geffen School of Medicine at UCLA, 11301 Wilshire Blvd, Los Angeles, CA, 90073, USA.
RTI Health Solutions, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709-2194, USA.
Drugs Real World Outcomes. 2024 Sep;11(3):501-511. doi: 10.1007/s40801-024-00436-z. Epub 2024 Aug 1.
In patients with heart failure with reduced ejection fraction (HFrEF), lower discharge heart rate (HR) is known to be associated with better outcomes. However, the effect of HR control on patient outcomes, and the demographic and clinical determinants of this association, are not well documented.
The purpose of this work was to evaluate the association between the HR control and the risk of post-discharge rehospitalization in patients hospitalized with HFrEF.
Data were collected using a retrospective medical record review in the USA. Reduction in HR between admission and discharge ("HR control") defined the primary exposure, categorized as no reduction, > 0 to < 20% reduction, and ≥ 20% reduction. Time to first rehospitalization in the post-discharge follow-up defined the study outcome and was analyzed using multivariable Cox regression modeling.
A total of 1002 patients were analyzed (median age, 63 years; median follow-up duration, 24.2 months). At admission, 59.1% received beta-blockers, 57.4% received diuretics, and 47.5% received angiotensin-converting enzyme (ACE) inhibitors. Most patients (90.5%) achieved some HR control (38.4% achieved > 0 to < 20% reduction, and 52% achieved ≥ 20% reduction). Approximately 39% were rehospitalized during the follow-up (14% within 30 days). In multivariable analysis, patients with > 0 to < 20% reduction in HR had a 39% lower risk of rehospitalization [hazard ratio 0.61; 95% confidence interval (CI) 0.43-0.85]; patients with ≥ 20% reduction in HR had a 38% lower rehospitalization risk (hazard ratio 0.62; 95% CI 0.45-0.87) than those with no HR reduction.
Reduction in HR between admission and discharge was associated with reduced risk for rehospitalization. Findings indicate HR control as an important goal in the management of patients hospitalized for HFrEF.
在射血分数降低的心力衰竭（HFrEF）患者中，已知出院时心率（HR）较低与更好的预后相关。然而，心率控制对患者预后的影响以及这种关联的人口统计学和临床决定因素尚未得到充分记录。
本研究旨在评估心率控制与因HFrEF住院患者出院后再住院风险之间的关联。
在美国，通过回顾性病历审查收集数据。入院至出院期间心率的降低（“心率控制”）定义为主要暴露因素，分为未降低、降低>0至<20%以及降低≥20%。出院后随访至首次再住院的时间定义为研究结局，并使用多变量Cox回归模型进行分析。
共分析了1002例患者（中位年龄63岁；中位随访时间24.2个月）。入院时，59.1%的患者接受了β受体阻滞剂，57.4%接受了利尿剂，47.5%接受了血管紧张素转换酶（ACE）抑制剂。大多数患者（90.5%）实现了一定程度的心率控制（38.4%的患者心率降低>0至<20%，52%的患者心率降低≥20%）。随访期间约39%的患者再次住院（30天内为14%）。在多变量分析中，心率降低>0至<20%的患者再住院风险降低39%[风险比0.61；95%置信区间（CI）0.43 - 0.85]；心率降低≥20%的患者再住院风险比未降低心率的患者降低38%（风险比0.62；95%CI 0.45 - 0.87）。
入院至出院期间心率降低与再住院风险降低相关。研究结果表明，心率控制是HFrEF住院患者管理中的一个重要目标。
