TY - JOUR
T1 - Prognostic Significance of Changes in Heart Rate Following Uptitration of Beta-Blockers in Patients with Sub-Optimally Treated Heart Failure with Reduced Ejection Fraction in Sinus Rhythm versus Atrial Fibrillation
AU - Mordi, Ify
AU - Santema, Bernadet T.
AU - Kloosterman, Marielle
AU - Choy, Anna-Maria
AU - Rienstra, Michiel
AU - Van Gelder, Isabelle C
AU - Anker, Stefan D.
AU - Cleland, John G. F.
AU - Dickstein, Kenneth
AU - Filippatos, Gerasimos S.
AU - van der Harst, Pim
AU - Hillege, Hans L.
AU - Metra, Marco
AU - Ng, Leong Loke
AU - Ouwerkerk, Wouter
AU - Ponikowski, Piotr
AU - Samani, Nilesh J.
AU - van Veldhuisen, Dirk Jan
AU - Zwinderman, Aeilko H.
AU - Zannad, Faiez
AU - Voors, Adriaan A.
AU - Lang, Chim
N1 - This project was funded by a grant from the European Commission: FP7-242209-BIOSTAT-CHF. This study was supported by the Dutch Heart Foundation, CVON 2014-11 RECONNECT. IRM is supported by a NHS Education for Scotland/Chief Scientist Office Postdoctoral Clinical Lectureship (PCL/17/07).
PY - 2019/7
Y1 - 2019/7
N2 - Background: In patients with heart failure with reduced ejection fraction (HFrEF) on sub-optimal doses of beta-blockers, it is conceivable that changes in heart rate following treatment intensification might be important regardless of underlying heart rhythm. We aimed to compare the prognostic significance of both achieved heart rate and change in heart rate following beta-blocker uptitration in patients with HFrEF either in sinus rhythm (SR) or atrial fibrillation (AF).Methods: We performed a post hoc analysis of the BIOSTAT-CHF study. We evaluated 1548 patients with HFrEF (mean age 67 years, 35% AF). Median follow-up was 21 months. Patients were evaluated at baseline and at 9 months. The combined primary outcome was all-cause mortality and heart failure hospitalisation stratified by heart rhythm and heart rate at baseline.Results: Despite similar changes in heart rate and beta-blocker dose, a decrease in heart rate at 9 months was associated with reduced incidence of the primary outcome in both SR and AF patients [HR per 10 bpm decrease—SR: 0.83 (0.75–0.91), p < 0.001; AF: 0.89 (0.81–0.98), p = 0.018], whereas the relationship was less strong for achieved heart rate in AF [HR per 10 bpm higher—SR: 1.26 (1.10–1.46), p = 0.001; AF: 1.08 (0.94–1.23), p = 0.18]. Achieved heart rate at 9 months was only prognostically significant in AF patients with high baseline heart rates (p for interaction 0.017 vs. low).Conclusions: Following beta-blocker uptitration, both achieved and change in heart rate were prognostically significant regardless of starting heart rate in SR, however, they were only significant in AF patients with high baseline heart rate.
AB - Background: In patients with heart failure with reduced ejection fraction (HFrEF) on sub-optimal doses of beta-blockers, it is conceivable that changes in heart rate following treatment intensification might be important regardless of underlying heart rhythm. We aimed to compare the prognostic significance of both achieved heart rate and change in heart rate following beta-blocker uptitration in patients with HFrEF either in sinus rhythm (SR) or atrial fibrillation (AF).Methods: We performed a post hoc analysis of the BIOSTAT-CHF study. We evaluated 1548 patients with HFrEF (mean age 67 years, 35% AF). Median follow-up was 21 months. Patients were evaluated at baseline and at 9 months. The combined primary outcome was all-cause mortality and heart failure hospitalisation stratified by heart rhythm and heart rate at baseline.Results: Despite similar changes in heart rate and beta-blocker dose, a decrease in heart rate at 9 months was associated with reduced incidence of the primary outcome in both SR and AF patients [HR per 10 bpm decrease—SR: 0.83 (0.75–0.91), p < 0.001; AF: 0.89 (0.81–0.98), p = 0.018], whereas the relationship was less strong for achieved heart rate in AF [HR per 10 bpm higher—SR: 1.26 (1.10–1.46), p = 0.001; AF: 1.08 (0.94–1.23), p = 0.18]. Achieved heart rate at 9 months was only prognostically significant in AF patients with high baseline heart rates (p for interaction 0.017 vs. low).Conclusions: Following beta-blocker uptitration, both achieved and change in heart rate were prognostically significant regardless of starting heart rate in SR, however, they were only significant in AF patients with high baseline heart rate.
KW - Atrial fibrillation
KW - Beta-blockers
KW - Heart failure
KW - Heart rate
UR - http://www.scopus.com/inward/record.url?scp=85059563150&partnerID=8YFLogxK
U2 - 10.1007/s00392-018-1409-x
DO - 10.1007/s00392-018-1409-x
M3 - Article
C2 - 30610382
SN - 1861-0684
VL - 108
SP - 797
EP - 805
JO - Clinical Research in Cardiology
JF - Clinical Research in Cardiology
IS - 7
ER -