Discharge heart rate and 1-year clinical outcomes in heart failure patients with atrial fibrillation  

作　　者：Fuwei Xing Xin Zheng Lihua Zhang Shuang Hu Xueke Bai Danli Hu Bing Li Jing Li 

机构地区：[1]Department of Cardiology,The First Affiliated Hospital of Sun Yat-Sen University,Guangzhou,Guangdong 510080,China [2]National Clinical Research Center for Cardiovascular Diseases,NHC Key Laboratory of Clinical Research for Cardiovascular Medications,State Key Laboratory of Cardiovascular Disease,Fuwai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,National Center for Cardiovascular Diseases,Beijing 100037,China [3]Department of Cardiology,The Third Hospital of Jilin University,Changchun,Jilin 130031,China

出　　处：《Chinese Medical Journal》2022年第1期52-62,共11页中华医学杂志（英文版）

基　　金：This work was supported by the National Key Research and Development Program from the Ministry of Science and Technology of China(No.2018YFC1312400);the CAMS Innovation Fund for Medical Science(No.2016-I2M-2-004,2017-I2M-2-002);the National Key Technology R&D Program from the Ministry of Science and Technology of China(No.2015BAI12B02);the 111 Project from the Ministry of Education of China(No.B16005)。

摘　　要：Background: The association between heart rate and 1-year clinical outcomes in heart failure (HF) patients with atrial fibrillation (AF), and whether this association depends on left ventricular ejection fraction (LVEF), are unclear. We investigated the relationship between discharge heart rate and 1-year clinical outcomes after discharge among hospitalized HF patients with AF, and further explored this association that differ by LVEF level.Methods: In this analysis, we enrolled 1760 hospitalized HF patients with AF from the China Patient-centered Evaluative Assessment of Cardiac Events Prospective Heart Failure study from August 2016 to May 2018. Patients were categorized into three groups with low (<65 beats per minute [bpm]), moderate (65-85 bpm), and high (≥86 bpm) heart rate measured at discharge.Cox proportional hazard models were employed to explore the association between heart rate and 1-year primary outcome, which was defined as a composite outcome of all-cause death and HF rehospitalization.Results: Among 1760 patients, 723 (41.1%) were women, the median age was 69 (interquartile range [IQR]: 60-77) years, median discharge heart rate was 75 (IQR: 69-84) bpm, and 934 (53.1%) had an LVEF <50%. During 1-year follow-up, a total of 792 (45.0%) individuals died or had at least one HF hospitalization. After adjusting for demographic characteristics, smoking status, medical history, anthropometric characteristics, and medications used at discharge, the groups with low (hazard ratio [HR]: 1.32, 95% confidence interval [CI]: 1.05-1.68,P = 0.020) and high (HR: 1.34, 95% CI: 1.07-1.67,P = 0.009) heart rate were associated with a higher risk of 1-year primary outcome compared with the moderate group. A significant interaction between discharge heart rate and LVEF for the primary outcome was observed (P for interaction was 0.045). Among the patients with LVEF ≥50%, only those with high heart rate were associated with a higher risk of primary outcome compared with the group with moderate heart rate (HR: 1.38, 95%

关 键 词：Atrial fibrillation Heart failure Heart rate Left ventricular ejection fraction 

分 类 号：R541.6[医药卫生—心血管疾病] R541.75[医药卫生—内科学]