Abstract 9232: Admission Heart Rate and In-Hospital Outcomes in Patients Hospitalized for Heart Failure
Background: Prior studies have suggested an association between higher heart rate (HR) and higher mortality, particularly in chronic heart failure (HF). Whether this relationship holds true in patients hospitalized with HF and differs between those in sinus rhythm (SR) and those in atrial fibrillation (AF) and by ejection fraction (EF) and has not been well studied.
Methods: We examined 145,211 admissions for HF from 295 hospitals enrolled in Get With The Guidelines-Heart Failure from January 2005 through September 2011.
Results: The median admission HR was 82 (IQR 70-97). Patients presenting at higher HR tended to be younger, have less comorbidities, and lower ejection fraction. In-hospital mortality had a J-shaped relationship with HR, with the lowest mortality rate with HR 70-75 (Figure). However, the relationship of mortality and HR differed between patients presenting in SR and AF: at HR above 100 bpm, the mortality curve for AF plateaued, whereas that for patients in SR continued to rise. The J-shaped curves remained similar for patients in HF with reduced EF and those with preserved EF, although patients in HF with preserved EF had a higher risk of mortality with increasing HR above 105 compared to those with reduced EF, but a lower risk of mortality below that cutpoint. After adjusting for patient and hospital characteristics, higher HR was associated with higher mortality (adjusted odds ratio [aOR] 1.26, 95% CI 1.22-1.31 per 10 bpm increase in HR) and longer length of stay (aOR 1.10, 95% CI 1.09-1.12 for LOS > 4days).
Conclusions: Higher admission HR is independently associated with worse outcomes in patients admitted for HF, in those in SR and AF and preserved and reduced EF. Whether early reduction in HR will improve short-term outcomes in patients hospitalized with HF is worthy of investigation. -.
- © 2012 by American Heart Association, Inc.