Abstract 10251: Achieved Dose of Beta-Blocker but not Achieved Heart Rate Predicts Clinical Outcomes in Heart Failure Patients With Atrial Fibrillation
Background: Little is known whether achieved heart rate is a surrogate maker during titration of β-blocker in heart failure (HF) with atrial fibrillation (AF). The purpose of this study was to clarify surrogate markers when titrating β-blocker among HF patients having reduced ejection fraction (HFrEF, EF<50%) with and without AF.
Methods: Of consecutive HFrEF patients who were hospitalized for HF at our hospital between 2002 and 2010, patients prescribed β-blocker on a de novo basis were retrospectively examined. Left ventricular EF and BNP was assessed 6 month after the titration of β-blocker. Median duration of follow-up was 36 month. Primary endpoint was hospitalization for HF and/or all-cause death.
Results: Of 253 patients who were enrolled in the study, 56 patients (21%) had AF. There were no significant differences in age and gender between HFrEF patients with and without AF (64.2±12.6 vs. 61.9±14.5 years; male 25% vs. 24%). During the follow-up, 36% and 28% in HFrEF patients with and without AF had the adverse events respectively (p=0.42). Multivariate Cox regression analysis showed that plasma levels of B-type natriuretic peptide (BNP), LVEF, and achieved heart rate were independent predictors for adverse outcomes in HFrEF without AF, whereas BNP levels and achieved fixed dose of β-blocker predicted the outcomes in HFrEF with AF (all, p<0.05). Subsequently, we performed ROC curve analysis to identify optimal cut-off points of the risk factors and then estimated its odds ratios (Table). On the basis of those results, we developed the risk scoring systems. The 3-year adverse event rates in the low- and high-risk groups were 8.9% and 64% among AF patients (AUC=0.726), whereas the rates in the low-, intermediate-, and high-risk groups were 8.8%, 24% and 60% among patients without AF (AUC=0.788).
Conclusions: Achieved heart rate is a predictor for cardiac events in only HFrEF patients without AF. The new scoring systems can stratify the prognosis in HFrEF with and without AF.
- © 2013 by American Heart Association, Inc.