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Circ Heart Fail. 2015 Sep;8(5):871-9. doi: 10.1161/CIRCHEARTFAILURE.115.002285. Epub 2015 Aug 4.

Prognostic Significance of Resting Heart Rate and Use of β-Blockers in Atrial Fibrillation and Sinus Rhythm in Patients With Heart Failure and Reduced Ejection Fraction: Findings From the Swedish Heart Failure Registry.

Author information

1
From the Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, Gothenburg, Sweden (S.-J.L., M.F.); Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China (S.-J.L.); Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, Stockholm, Sweden (U.S.); Department of Molecular Medicine and Surgery (U.S.), Unit of Cardiology, Department of Medicine (L.H.L.), Karolinska Institute, Stockholm, Sweden; Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden (U.D.); and Centre for Applied Biostatistics, University of Gothenburg, Gothenburg, Sweden (M.A., M.P.).
2
From the Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, Gothenburg, Sweden (S.-J.L., M.F.); Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China (S.-J.L.); Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, Stockholm, Sweden (U.S.); Department of Molecular Medicine and Surgery (U.S.), Unit of Cardiology, Department of Medicine (L.H.L.), Karolinska Institute, Stockholm, Sweden; Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden (U.D.); and Centre for Applied Biostatistics, University of Gothenburg, Gothenburg, Sweden (M.A., M.P.). Michael.fu@vgregion.se.

Abstract

BACKGROUND:

In heart failure and reduced ejection fraction, the prognostic role of heart rate (HR) in atrial fibrillation (AF) is unknown and the effectiveness of β-blockers has recently been questioned in AF.

METHODS AND RESULTS:

A total of 18 858 patients with heart failure and reduced ejection fraction registered with Swedish Heart Failure Registry were included in this study: patients with sinus rhythm (SR; n=11 466) and patients with AF (n=7392). The outcome measure was all-cause mortality. Compared with HR ≤60 beats per minute, the adjusted hazard ratios for mortality in SR were 1.26 for HR=61 to 70 beats per minute, 1.37 for HR=71 to 80 beats per minute, 1.52 for HR=81 to 90 beats per minute, 1.63 for HR=91 to 100 beats per minute, and 2.69 for HR >100 beats per minute. However, in AF, the hazard ratio increased only for HR >100 beats per minute (1.30; P=0.001). β-blocker use was associated with reduced mortality in SR (hazard ratio, 0.77; P=0.011) and in AF (hazard ratio, 0·71; P<0.001). For β-blocker use in SR, the hazard ratio gradually increased with HR increment, whereas in AF, the hazard ratio significantly increased only for HR >100 beats per minute (1.29; P=0.003) compared with HR ≤60 beats per minute.

CONCLUSIONS:

In patients with heart failure and reduced ejection fraction, a higher HR was associated with increased mortality in SR, but in AF, this is true only for HR >100 beats per minute. β-blocker use was associated with reduced mortality both in SR and in AF.

KEYWORDS:

atrial fibrillation; heart failure; heart rate; mortality; registries

[Indexed for MEDLINE]

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