Repeated Heart Rate Measurement and Cardiovascular Outcomes in Left Ventricular Systolic Dysfunction

• Published in: The American journal of medicine Vol. 128; no. 10; pp. 1102 - 1108.e6
• Main Authors: Hamill, Victoria, PhD, Ford, Ian, PhD, Fox, Kim, MD, Böhm, Michael, MD, PhD, Borer, Jeffrey S., MD, Ferrari, Roberto, MD, PhD, Komajda, Michel, MD, Steg, Philippe Gabriel, MD, Tavazzi, Luigi, MD, PhD, Tendera, Michal, MD, PhD, Swedberg, Karl, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2015; Elsevier Sequoia S.A
• Subjects: Adult; Aged; association; BEAUTIFUL; Cardiac and Cardiovascular Systems; Cardiology; Cardiovascular disease; Clinical outcomes; controlled-trial; coronary-artery-disease; failure patients; Female; General & Internal Medicine; guidelines; Heart Failure - diagnosis; Heart Failure - etiology; Heart Failure - mortality; Heart Rate; Hospitalization; Humans; Internal Medicine; ivabradine; Kardiologi; Left ventricular systolic dysfunction; Male; Medical prognosis; Middle Aged; Myocardial Infarction - diagnosis; Myocardial Infarction - etiology; Myocardial Infarction - mortality; Prognosis; Proportional Hazards Models; risk-factor; SHIFT; task-force; Time Factors; Ventricular Dysfunction, Left - complications; Ventricular Dysfunction, Left - mortality; Ventricular Dysfunction, Left - physiopathology; Heart rate; SHIFT; BEAUTIFUL; Left ventricular systolic dysfunction; Prognosis
• ISSN: 0002-9343; 1555-7162
• DOI: 10.1016/j.amjmed.2015.04.042

Abstract Background Elevated resting heart rate is associated with increased cardiovascular risk, particularly in patients with left ventricular systolic dysfunction. Heart rate is not monitored routinely in these patients. We hypothesized that routine monitoring of heart rate would increase its prognostic value in patients with left ventricular systolic dysfunction. Methods We analyzed the relationship between heart rate measurements and a range of adverse cardiovascular outcomes, including hospitalization for worsening heart failure, in the pooled placebo-treated patients from the morBidity-mortality EvAlUaTion of the If inhibitor ivabradine in patients with coronary disease and left ventricULar dysfunction (BEAUTIFUL) trial and Systolic Heart failure treatment with the If inhibitor ivabradine (SHIFT) Trial, using standard and time-varying covariate Cox proportional hazards models. By adjusting for other prognostic factors, models were fitted for baseline heart rate alone or for time-updated heart rate (latest heart rate) alone or corrected for baseline heart rate or for immediate previous time-updated heart rate. Results Baseline heart rate was strongly associated with all outcomes apart from hospitalization for myocardial infarction. Time-updated heart rate increased the strengths of associations for all outcomes. Adjustment for baseline heart rate or immediate previous time-updated heart rate modestly reduced the prognostic importance of time-updated heart rate. For hospitalization for worsening heart failure, each 5 beats/min increase in baseline heart rate and time-updated heart rate was associated with a 15% (95% confidence interval, 12-18) and 22% (confidence interval, 19-40) increase in risk, respectively. Even after correction, the prognostic value of time-updated heart rate remained greater. Conclusions In patients with left ventricular systolic dysfunction, time-updated heart rate is more strongly related with adverse cardiovascular outcomes than baseline heart rate. Heart rate should be measured to assess cardiovascular risk at all assessments of patients with left ventricular systolic dysfunction.