Abstract 15851: Does Resting Heart Rate Predict Poor Outcome in Patients Who Have Heart Failure With Preserved Ejection Fraction?
INTRODUCTION: Heart failure (HF) is a complex clinical syndrome with high morbidity and mortality. For patients who have heart failure with preserved ejection fraction (HFpEF) increased heart rate (HR) impairs ventricular filling and delays relaxation. There is growing evidence of an association between elevated HR and increased cardiovascular risk. There have also been experimental and observational studies suggesting that increased HR is associated with a worse prognosis in HFpEF patients so better HR control could be a therapeutic target. We analysed the impact of baseline HR on long term outcome in patients with HFpEF and those with heart failure and reduced ejection fraction (HFrEF) as well as the impact of beta-blockers.
RESULTS: From Jan 2002- Dec 2007, 1034 patients were referred to the HF clinic. Of these 270 (26%) were diagnosed with HFrEF & 242 (23%) fulfilled the diagnostic criteria for HFpEF. Non HF was diagnosed in the remainder. Patients were followed up for average 5.5 years (3-8.5 yrs). Compared to those with HFrEF, HFpEF patients were older, more likely to be female & were more likely to have hypertension, AF & diabetes. Mortality was high in both groups: HFrEF 163(60%) & HFpEF 119(50%) (P=0.018). Median HR in the HFpEF group was 77. In Cox regression analysis baseline HR of ≥ 78 / min was significantly associated with increased all-cause mortality [OR = 1.429, p = 0.05, 95% CI: 0.994, 2.055] and with a trend to increased hospitalisation [OR = 1.349, p = 0.06, 95% CI 0.983 - 1.852] . HFpEF patients taking beta blockers had a better outcome [OR = 0.68, p = 0.04, 95% CI: 0.471, 0.992]. However other risk factors including gender, history of hypertension, atrial fibrillation, diabetes, ischemic heart disease and prior stroke were not significantly related to survival. Median HR banding at baseline, before initiation of beta blockers, was not significantly related to all-cause mortality in the HFrEF group [OR = 1.048, p = 0.79, 95% CI: 0.741, 1.482]
CONCLUSION: In patients with HFpEF an elevated HR at baseline is an independent predictor of all cause mortality. The use of beta-blockers was associated with significantly better outcome. These data suggest a potential therapeutic target in HFpEF patients.
- © 2013 by American Heart Association, Inc.