Abstract 11724: Increased Heart Rate as a Significant Prognostic Factor in Patients with Heart Failure with Preserved Ejection Fraction -A Report from the CHART-2 Study-
Background: Although heart failure (HF) with preserved ejection fraction (HFpEF) accounts for more than half of overall HF, its appropriate management has not been established. Since HFpEF is generally complicated with diastolic dysfunction and thus could be further worsened by an increase in HR, it is anticipated that heart rate (HR) control is particularly crucial for the management of HFpEF as compared with HF with reduced EF (HFrEF). In this study, we thus examined the influence of HR control status on cardiovascular (CV) mortality in patients with HFpEF and those with HFrEF.
Methods: Among the 10,219 patients registered in our CHART-2 Study (Chronic Heart Failure Analysis and Registry in the Tohoku District 2), we enrolled 2,978 patients with Stage C/D HF and sinus rhythm (mean age 67.8 years, 69.0% male). CV mortality during the mean follow-up period of 2.9 years was compared among the following 4 groups; G1 (n=1121, HR<71bpm, EF≥50%), G2 (n=853, HR≥71bpm, EF≥50%), G3 (n=491, HR<71bpm, EF<50%), and G4 (n=513, HR≥71bpm, EF<50%).
Results: Compared with lower HR groups (G1, G3), higher HR groups (G2, G4) were characterized by female gender (G1, 31.1; G2, 36.3; G3, 23.8; and G4, 29.9%) and younger age (G1, 68.5; G2, 67.9; G3, 67.3, and G4, 66.2 years). G2 had a significantly higher CV mortality than G1 (6.0 vs. 3.6%, log-rank test; P=0.009), whereas G3 and G4 had similar CV mortality (10.0 vs. 9.9%, log-rank test; P=0.740) (Figure). After adjustment with age, sex and other covariates, Cox proportional hazard regression analysis revealed that G2 was significantly associated with higher CV mortality than G1 (hazard ratio 1.79, 95% confidence interval (CI) 1.17-2.74, P=0.008), whereas G3 showed comparable prognosis to G4 (hazard ratio 0.85, 95%CI 0.57-1.27, P=0.418).
Conclusions: These results indicate that increased HR is associated with worse prognosis in patients with HFpEF but not in those with HFrEF, suggesting that HR could be a therapeutic target for HEpEF but not for HFrEF.
- © 2012 by American Heart Association, Inc.