Abstract 11978: Impact of Heart Rate and Beta-blockers on Mortality in Patients With Heart Failure and Preserved Ejection Fraction
Background: Heart failure (HF) can be associated with a higher resting heart rate (HR) and an elevated HR is associated with adverse long-term events in patients with HF and reduced ejection fraction (EF). However, the mechanistic and causal role of HR in HF and preserved EF (HFpEF) is unclear. This study aimed to investigate the association between HR and clinical outcomes as well as an interaction with beta-blocker therapy in patients with HFpEF.
Methods and Results: Among 3,445 HFpEF patients who were enrolled in the Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist (TOPCAT) Trial, we studied 2542 (74%) patients without atrial fibrillation or pacemaker implantaion. In our study cohort (mean age 67±9 years, 54% male and 32% diabetic), the median baseline HR was 68 bpm (interquartile range 60 to 74 bpm) and 1954 (77%) patients had beta-blocker medication at baseline although all the study patients had preserved EF (>45%). There were 329 deaths during median follow-up of 3.5 years. Higher HR was associated with poor long-term survival (Quartile-4 versus 1: hazard ratio [95% confidence interval] 1.82 [1.28 to 2.36], P < 0.001, Figure), while the prognosis was comparable between patients with and without beta-blocker medication (P=0.27). After adjusting for age, gender, hypertension, dyslipidemia, diabetes mellitus, serum creatinine level, coronary artery disease, stroke, beta-blocker and angiotensin converting enzyme inhibitor or angiotensin receptor antagonist, HR was still independently associated with mortality risk (2.09 [1.44 to 2.75], P < 0.001). Beta-blocker medication had no significant interaction effects with HR.
Conclusions: Higher HR was associated with poor survival in HFpEF patients with or without beta-blocker. Further studies are warranted to investigate whether HR modification improve outcomes in patients with HFpEF.
Author Disclosures: T. Kitai: None. J.L. Grodin: None. W. Tang: None.
- © 2016 by American Heart Association, Inc.