Abstract 20774: Discharge Heart Rate and Outcomes in Hospitalized Patients With Heart Failure and Preserved Ejection Fraction (HFpEF) and Stable Admission-to-Discharge Heart Failure
Background: A lower heart rate (HR) has been shown to be associated with improved outcomes in patients with stable chronic HF. However, this association has not been well studied in hospitalized patients with HFpEF. We examined if a low discharge HR among hospitalized HFpEF patients with a stable admission-to-discharge HR was independently associated with better outcomes.
Methods: In the Medicare-linked OPTIMIZE-HF registry, 10482 hospitalized patients with HF had EF >40%. A stable admission-to-discharge HR was defined as HR fluctuation of <20 beats per minute (bpm) between hospital admission and discharge. Of the 7412 patients with stable HR, 1325 (28%) had a discharge HR of <70 bpm. Propensity scores for discharge HR of <70 bpm, estimated for each of the 7412 patients, were used to assemble a cohort of 2398 pairs of patients, with a discharge HR <70 vs ≥70 bpm, who were balanced on 58 baseline characteristics. The 4796 matched patients had a mean (±SD) age of 79 (±10) years, a mean (±SD) EF of 57 (±8) percent, a mean (±SD) discharge HR of 71 (±12) bpm, 63% were women, and 10% African American.
Results: During 2.7 years of median follow-up (max, 6.0 years), all-cause mortality occurred in 66% and 70% of matched patients with a discharge HR <70 vs ≥70 bpm, respectively (HR, 0.88; 95% CI, 0.82–0.94; Figure). A discharge HR <70 bpm was also associated with a lower risk for the combined outcome of HF readmission or all-cause mortality (HR, 0.90; 95% CI, 0.85–0.96) but not with all-cause readmission (HR, 0.99; 95% CI, 0.93–1.05) or HF readmission (HR, 0.94; 95% CI, 0.87–1.02). These associations remained unchanged when we repeated the above analyses among the 7412 pre-match patients, adjusting for propensity scores.
Conclusion: Among hospitalized patients with HFpEF and stable admission-to-discharge HR, a low discharge HR was independently associated with lower all-cause mortality but not with all-cause or HF readmissions.
Author Disclosures: P. Deedwania: None. P.H. Lam: None. G. Panjrath: None. D.J. Dooley: None. C. Arundel: None. G. Filippatos: None. J. Butler: None. C. Morgan: None. M. Blackman: None. R. Fletcher: None. M. White: None. W. Wu: None. S.D. Anker: None. G.C. Fonarow: None. A. Ahmed: None.
- © 2016 by American Heart Association, Inc.