Kishihara Makoto, Kawakami Ryoko, Fukushima Noritoshi, Abe Takuro, Takada Takuma, Shirotani Shota, Yoshida Ayano, Hata Takehiro, Watanabe Shonosuke, Kawamoto Takanori, Hasegawa Shun, Yamaguchi Junichi, Jujo Kentaro
Department of Cardiology, Saiseikai Kazo Hospital, Saitama, Japan.
Physical Fitness Research Institute, Meiji Yasuda Life Foundation of Health and Welfare, Tokyo, Japan.
JACC Adv. 2024 Jul 24;3(8):101120. doi: 10.1016/j.jacadv.2024.101120. eCollection 2024 Aug.
Managing heart rate (HR) is crucial for enhancing clinical prognosis in patients with heart failure (HF) and atrial fibrillation (AF). Nevertheless, the prognostic impact of HR at discharge in hospitalized HF patients remains unclear.
This study aimed to determine the HR associated with the lowest risk of death and HF in patients hospitalized with HF and AF.
In this observational study, 334 persistent AF patients were analyzed from a database of 1,930 consecutive HF hospitalizations. Exclusion criteria included sinus rhythm or paroxysmal AF, cardiac pacemakers, or unrecorded HR at discharge. Participants were divided into four groups based on HR at discharge in 10 beats/min increments. The primary endpoint was a composite of death from any cause and rehospitalization due to HF. The association between resting HR and the primary endpoint was determined using Kaplan-Meier analysis and Cox proportional hazards models.
The median follow-up period was 389 days, with 133 patients (39.8%) reaching the primary endpoint. Kaplan-Meier analysis revealed a significantly higher primary endpoint incidence in patients with HR >81 beats/min at discharge compared to those with HR <60 beats/min (log-rank test for trend: = 0.039). Multivariable Cox regression analysis showed that HR >81 beats/min at discharge was associated with the primary endpoint, with a hazard ratio of 1.79 (95% CI: 1.04-3.07), compared to HR <60 beats/min.
The findings suggest that controlling HR to less than 80 beats/min at discharge may lead to better clinical outcomes in patients with HF and persistent AF.
控制心率（HR）对于改善心力衰竭（HF）合并心房颤动（AF）患者的临床预后至关重要。然而，住院HF患者出院时心率对预后的影响仍不明确。
本研究旨在确定HF合并AF住院患者中与死亡和HF风险最低相关的心率。
在这项观察性研究中，从1930例连续性HF住院患者数据库中分析了334例持续性AF患者。排除标准包括窦性心律或阵发性AF、心脏起搏器或出院时未记录心率。根据出院时心率以10次/分钟为增量将参与者分为四组。主要终点是任何原因导致的死亡和因HF再次住院的复合终点。使用Kaplan-Meier分析和Cox比例风险模型确定静息心率与主要终点之间的关联。
中位随访期为389天，133例患者（39.8%）达到主要终点。Kaplan-Meier分析显示，出院时心率>81次/分钟的患者主要终点发生率显著高于心率<60次/分钟的患者（趋势对数秩检验：=0.039）。多变量Cox回归分析显示，出院时心率>81次/分钟与主要终点相关，与心率<60次/分钟相比，风险比为1.79（95%CI：1.04-3.07）。
研究结果表明，将HF合并持续性AF患者出院时心率控制在80次/分钟以下可能会带来更好的临床结局。
