Eur Heart J Acute Cardiovasc Care. 2018 Mar;7(2):149-157. doi: 10.1177/2048872616672077. Epub 2016 Sep 30.

Heart rate at admission is a predictor of in-hospital mortality in patients with acute coronary syndromes: Results from 58 European hospitals: The European Hospital Benchmarking by Outcomes in acute coronary syndrome Processes study.

Jensen MT¹, Pereira M², Araujo C^2,³, Malmivaara A⁴, Ferrieres J⁵, Degano IR⁶, Kirchberger I^7,⁸, Farmakis D⁹, Garel P¹⁰, Torre M¹¹, Marrugat J⁶, Azevedo A^2,¹².

Author information

1: 1 Holbæk Hospital, University of Copenhagen, Denmark.
2: 2 EPI Unit, Institute of Public Health of the University of Porto, Portugal.
3: 3 Department of Cardiology, Centro Hospitalar Trás-os-Montes-e-Alto-Douro, Portugal.
4: 4 National Institute for Health and Welfare THL, Finland.
5: 5 Department of Cardiology, Rangueil Hospital of Toulouse, France.
6: 6 Hospital del Mar, Spain.
7: 7 Helmholtz Center Munich, German Research Center for Environment and Health, Germany.
8: 8 MONICA/KORA Myocardial Infarction Registry, Central Hospital of Augsburg, Germany.
9: 9 University of Athens, Greece.
10: 10 European Hospital and Healthcare Federation, Belgium.
11: 11 National Institute of Health, Italy.
12: 12 Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Portugal.

Abstract

AIMS:

The purpose of this study was to investigate the relationship between heart rate at admission and in-hospital mortality in patients with ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation acute coronary syndrome (NSTE-ACS).

METHODS:

Consecutive ACS patients admitted in 2008-2010 across 58 hospitals in six participant countries of the European Hospital Benchmarking by Outcomes in ACS Processes (EURHOBOP) project (Finland, France, Germany, Greece, Portugal and Spain). Cardiogenic shock patients were excluded. Associations between heart rate at admission in categories of 10 beats per min (bpm) and in-hospital mortality were estimated by logistic regression in crude models and adjusting for age, sex, obesity, smoking, hypertension, diabetes, known heart failure, renal failure, previous stroke and ischaemic heart disease. In total 10,374 patients were included.

RESULTS:

In both STEMI and NSTE-ACS patients, a U-shaped relationship between admission heart rate and in-hospital mortality was found. The lowest risk was observed for heart rates between 70-79 bpm in STEMI and 60-69 bpm in NSTE-ACS; risk of mortality progressively increased with lower or higher heart rates. In multivariable models, the relationship persisted but was significant only for heart rates >80 bpm. A similar relationship was present in both patients with or without diabetes, above or below age 75 years, and irrespective of the presence of atrial fibrillation or use of beta-blockers.

CONCLUSION:

Heart rate at admission is significantly associated with in-hospital mortality in patients with both STEMI and NSTE-ACS. ACS patients with admission heart rate above 80 bpm are at highest risk of in-hospital mortality.