Mody FV, Goyal RK, Ajmera M, Cainzos-Achirica M, Davis KL, Lindstrom RC, Globe G, Riebman JB, Wirtz HS, Amin A. Exploring the association between heart rate control and patient outcomes: a retrospective medical record review of patients hospitalized with systolic heart failure. Poster presented at the 2019 Heart Failure Society of America 23rd Annual Scientific Meeting; September 14, 2019. Philadelphia, PA. [abstract] J Card Fail. 2019 Aug; 25(8 Supplement):S156. doi: 10.1016/j.cardfail.2019.07.447

INTRODUCTION: Previous studies report an association between elevated heart rate (HR) and increased mortality and rehospitalizations in patients with HFrEF and have also found that reduction in HR reduced HF rehospitalization. Hypothesis: We hypothesized that for patients with an index HFrEF-related hospital admission, HR at discharge and change in HR between hospital admission and discharge would be associated with subsequent increased risk for rehospitalization.

METHODS: 180 US physicians contributed record abstraction data for patients hospitalized with a confirmed, primary diagnosis of HFrEF defined as LVEF ≤35% + ≥1 at admission: administration of an IV diuretic, BNP levels >200pg/mL, or Nterminal proBNP levels >600pg/mL. The association of HR at discharge and change in HR from admission to discharge with rehospitalization at any time post-discharge were assessed using multivariable Cox regression analysis.

RESULTS: 1002 patients (63% male, mean±SD age 62.5±13.3y, LVEF 27.2±6.0%) were included. At admission, 59% of patients were prescribed beta blockers (BB); 48%, ACE inhibitors (ACEi); and ARBs, 17%. At discharge, 71% received BB; 54%, ACEi; and 19%, ARBs. Among all patients, 39% had ≥1 post-discharge rehospitalization anytime (14% within 30 days). Mean HR at discharge was 73.51±11.47. HR at discharge of >80bpm (n=188) had a trend towards increased rehospitalization (hazard ratio=1.28, CI 0.98-1.68, P=0.07). The mean change in HR from admission to discharge was −19.5±17.2bpm. Mean change in HR correlated significantly with rehospitalization rate. Patients with >0%-20% reduction in HR (hazard ratio=0.61, 95%CI 0.43-0.85, P=0.004) and >20% reduction (0.62, 0.45-0.87, P=0.005) were less likely to be rehospitalized when compared to patients with no change or an increase (Figure).

CONCLUSIONS: In patients with HFrEF receiving similar treatment as reported in large registries, a reduction in HR during a HFrEF-related admission is associated with reduced rehospitalization. Further investigation of clinical drivers of change in HR could potentially identify management strategies to reduce rehospitalization.