Clinical impact of heart rate change in patients with acute heart failure in the early phase

• Published in: ESC Heart Failure Vol. 8; no. 4; pp. 2982 - 2990
• Main Authors: Kazama, Shingo, Kondo, Toru, Shibata, Naoki, Hiraiwa, Hiroaki, Nishiyama, Itsumure, Kato, Toshiaki, Sawamura, Akinori, Kimura, Yuki, Oishi, Hideo, Kuwayama, Tasuku, Morimoto, Ryota, Okumura, Takahiro, Shimizu, Kiyokazu, Murohara, Toyoaki
• Format: Journal Article
• Language: English
• Published: England John Wiley & Sons, Inc 01.08.2021; John Wiley and Sons Inc; Wiley
• Subjects: Acute heart failure; Age; Atrial fibrillation; Blood pressure; Cardiac arrhythmia; Creatinine; Ejection fraction; Heart failure; Heart rate; Hospitalization; Medical prognosis; Original; Original s; Pacemakers; Peptides; Sinus rhythm; Sinuses; Survival analysis; Values; New York; United States > US; Heart rate; Sinus rhythm; Atrial fibrillation; Acute heart failure
• ISSN: 2055-5822; 2055-5822
• DOI: 10.1002/ehf2.13388

Aims Patients with acute heart failure (AHF) often present with an increased heart rate (HR), and the HR changes dramatically after initial treatment for AHF. However, the HR change after admission and the relationship between HR change in the early phase and prognosis have not been fully elucidated. Methods and results From a multicentre AHF registry, we retrospectively evaluated 1527 consecutive patients admitted with AHF. HR change (%) was calculated by [HR (at admission) − HR (24 h after admission)] × 100∕HR (at admission). The median HR change was 15.1% (range, 2.0–28.4%). The HR decreased most in the first 24 h and then gradually thereafter [admission: 98 (81–117) b.p.m., 24 h: 80 (70–92) b.p.m., 48 h: 78 (68–90) b.p.m., and 72 h: 77 (67–88) b.p.m.]. In Kaplan–Meier analysis, the cumulative event‐free rates in the composite endpoint of death and rehospitalization due to AHF showed better according to larger HR change (P = 0.012, log rank). Cox proportional hazards analysis showed that HR change was a prognostic factor for composite endpoint adjusted by age and sex [hazard ratio, 0.995; 95% confidence interval (CI), 0.991–0.998; P = 0.006]. HR change was associated with outcome adjusted by age and sex in patients with sinus rhythm (hazard ratio, 0.993; 95% CI, 0.988–0.999; P = 0.015), but not in patients with atrial fibrillation (hazard ratio, 0.996; 95% CI, 0.990–1.002; P = 0.15). Conclusions A decrease in HR in the first 24 h after admission indicates better prognosis in patients with AHF, although the prognostic influence may differ between patients with sinus rhythm and those with atrial fibrillation.