Kodani Eitaro, Yamashita Takeshi, Inoue Hiroshi, Atarashi Hirotsugu, Okumura Ken, Origasa Hideki
Department of Cardiovascular Medicine, Nippon Medical School Tama Nagayama Hospital, Tokyo, Japan.
The Cardiovascular Institute, Tokyo, Japan.
Clin Cardiol. 2025 Apr;48(4):e70122. doi: 10.1002/clc.70122.
We previously reported that the heart rate (HR) at the time closest to an event or at the last visit during the follow-up period (HR-end) was more closely associated with adverse events (AEs) than baseline HR in patients with non-valvular atrial fibrillation (NVAF). However, it remains uncertain whether changes in HR during the follow-up period or absolute HR values would be more closely associated with AEs. Thus, we performed post hoc analyses using data from the J-RHYTHM Registry.
Of 7406 outpatients with NVAF from 158 institutions, 6886 (age, 69.8 ± 9.9 years; men, 70.8%), who had both baseline HR and HR-end data, were included. Patients were divided into five groups based on the changing patterns of HR quartiles from baseline (< 63, 63-70, 71-79, and ≥ 80 beats per minute) to the end of follow-up (no-change, down-to-the-lowest-quartile, down-to-the-2nd or -3rd-quartile, up-to-the-2nd or -3rd-quartile, and up-to-the-highest-quartile).
Hazard ratios for AEs were significantly higher only in the up-to-highest-quartile group (2.89 [95% confidence interval, 1.71-4.90] for thromboembolism, 2.46 [1.53-3.95] for major hemorrhage, and 2.36 [1.51-3.70] for all-cause death) compared with the no-change group, after adjusting for confounding factors. Furthermore, in the no-change group, hazard ratios for AEs were significantly higher in the highest-to-highest-quartile subgroup (5.55 [1.49-20.77] for major hemorrhage and 3.60 [1.03-12.53] for all-cause death) compared with the 2nd-to-2nd-quartile subgroup.
Both excessive increases in HR and consistently high HR were independently associated with AEs in patients with NVAF. By contrast, modest decrease in HR during follow-up was associated with lower mortality. Accordingly, it is important to pay attention to changes in HR during follow-up for the management of patients with AF.
The J-RHYTHM Registry is registered in the University Hospital Medicine Information Network (UMIN) Clinical Trials Registry (unique identifier: UMIN000001569) http://www.umin.ac.jp/ctr/.
我们之前报告过，在非瓣膜性心房颤动（NVAF）患者中，随访期间最接近事件发生时或最后一次就诊时的心率（HR-end）比基线心率与不良事件（AE）的关联更为密切。然而，随访期间心率的变化或绝对心率值是否与不良事件的关联更为密切仍不确定。因此，我们使用J-RHYTHM注册研究的数据进行了事后分析。
来自158家机构的7406例NVAF门诊患者中，6886例（年龄69.8±9.9岁；男性占70.8%）有基线心率和HR-end数据，被纳入研究。根据心率四分位数从基线（<63、63 - 70、71 - 79和≥80次/分钟）到随访结束时的变化模式（无变化、降至最低四分位数、降至第二或第三四分位数、升至第二或第三四分位数、升至最高四分位数）将患者分为五组。
在调整混杂因素后，与无变化组相比，仅升至最高四分位数组的不良事件风险比显著更高（血栓栓塞为2.89[95%置信区间，1.71 - 4.90]，大出血为2.46[1.53 - 3.95]，全因死亡为2.36[1.51 - 3.70]）。此外，在无变化组中，与第二至第二四分位数亚组相比，最高至最高四分位数亚组的不良事件风险比显著更高（大出血为5.55[1.49 - 20.77]，全因死亡为3.60[1.03 - 12.53]）。
心率过度增加和持续高心率均与NVAF患者的不良事件独立相关。相比之下，随访期间心率适度降低与较低死亡率相关。因此，在房颤患者管理中，关注随访期间心率变化很重要。
J-RHYTHM注册研究已在大学医院医学信息网络（UMIN）临床试验注册中心注册（唯一标识符：UMIN000001569）http://www.umin.ac.jp/ctr/ 。
