Discharge heart rate and clinical outcomes in hospitalized heart failure patients with coexisted atrial fibrillation

Abstract Background Whether discharge heart rate for hospitalized heart failure (HF) patients with coexisted atrial fibrillation (AF) is associated with long-term clinical outcomes and whether this association differs between patients with and without beta-blockers have not been well studied. Purpose We investigated the associations between discharge heart rate and clinical outcomes in hospitalized HF patients with coexisted AF, while stratified to beta-blockers at discharge. Methods The study cohort included 1631 HF patients hospitalized primarily with AF, which was from the China PEACE Prospective Heart Failure Study. Clinical outcome was 1-year combined all-cause mortality and HF hospitalization after discharge. We analyzed association between outcome and heart rate at discharge with restricted cubic spline and Cox proportional hazard ratios (HR). Results The median age was 68 (IQR: 60- 77) years, 41.9% were women, discharge heart rate was (median (IQR)) 75 (69- 84) beats per minute (bpm), and 60.2% received beta-blockers at discharge. According to the result of restricted cubic spline plot, the relationship between discharge heart rate and clinical outcome may be nonlinear (P<0.01). Based on above result, these patients were divided into 3 groups: lowest <65 bpm, middle 65–86 bpm and highest ≥87 bpm, clinical outcomes occurred in 128 (64.32%), 624 (53.42%) and 156 (59.32%) patients in the lowest, middle, and highest groups respectively. In the Cox proportional hazard analysis, the lowest and highest groups were associated with increased risks of clinical outcome compared with the middle group (HR: 1.289, 95% confidence interval (CI): 1.056 - 1.573, p=0.013; HR: 1.276, 95% CI: 1.06 - 1.537, p=0.01, respectively). And a significant interaction between discharge heart rate and beta-blocker use was observed (P<0.001 for interaction). Stratified analysis showed the lowest group was associated with increased risks of clinical outcomes in patients with beta-blockers (HR: 1.584, 95% confidence interval (CI): 1.215–2.066, p=0.001). Conclusion There may be a U-curve relationship between discharge heart rate and clinical outcomes in hospitalized HF patients with coexisted AF. They may have the best clinical outcomes with heart rates of 65 - 86 bpm. And strict heart rate control (<65 bpm) may be avoided for patients who discharge with beta-blockers. Figure 1 Funding Acknowledgement Type of funding source: Other. Main funding source(s): This work was supported by the National Key Research and Development Program (2017YFC1310803) from the Ministry of Science and Technology of China; the CAMS Innovation Fund for Medical Science (2017-I2M-B&R-02); the 111 Project from the Ministry of Education of China (B16005).

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Discharge heart rate and beta-blockers treatments in hospitalized heart failure patients with coexisted atrial fibrillation

European Heart Journal ◽

10.1093/ehjci/ehaa946.1054 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

F Xing ◽

X Bai ◽

J Li

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Heart Rate ◽

Clinical Outcome ◽

Clinical Outcomes ◽

Beta Blockers ◽

Hazard Ratio ◽

Funding Source ◽

Proportional Hazard ◽

Cox Proportional Hazard

Abstract Background Beta-blockers are widely used to improve clinical outcomes in heart failure (HF) patients. However, the effects of beta-blockers on clinical outcomes in those who have coexisted atrial fibrillation (AF) remains uncertain. Purpose We investigated the associations between beta-blockers and clinical outcomes according to discharge heart rate. Methods The study cohort included 1631 HF patients hospitalized primarily with AF, which was from the China PEACE Prospective Heart Failure Study. Clinical outcome was 1-year combined all-cause mortality and HF hospitalization after discharge. The associations between beta-blockers and clinical outcome were assessed using Cox proportional hazard and standardization mortality weighting regression models, with stratified discharge heart rate group predefined by restricted cubic spline. Results The median age was 68 (IQR: 60- 77) years, 41.9% were women, discharge heart rate was (median (IQR)) 75 (69- 84) beats per minute (bpm), and 60.2% received beta-blockers at discharge. According to the result of restricted cubic spline plot, these patients were divided into 3 groups: lowest <65 bpm, middle 65–86 bpm and highest ≥87 bpm (Fig.1). In the Cox proportional hazard analysis, a significant interaction between discharge heart rate and beta-blocker use was observed (P<0.001 for interaction). Stratified analysis showed beta-blocker prescription at discharge was associated with reduced risk for clinical outcomes in patients with high heart rates (hazard ratio 0.336, 95% CI: 0.144–0.786, p=0.012) but not in those with lowest and middle heart rates (hazard ratio: 1.32; 95% CI, 0.95–1.63; hazard ratio: 1.02; 95% CI, 0.68–1.55, respectively). Conclusion The associations between beta-blockers and clinical outcomes may be significantly influenced by baseline heart rate. Hospitalized HF patients with AF benefit the most from beta-blockers use if they had high heart rate (≥87 bpm) at discharge. Figure 1 Funding Acknowledgement Type of funding source: Other. Main funding source(s): This work was supported by the National Key Research and Development Program (2017YFC1310803) from the Ministry of Science and Technology of China; the CAMS Innovation Fund for Medical Science (2017-I2M-B&R-02); the 111 Project from the Ministry of Education of China (B16005).

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Impacts of beta-blockers on lone term clinical outcomes in the treatment of hospitalized heart failure patients with an ejection fraction greater than 40%

European Heart Journal ◽

10.1093/ehjci/ehaa946.1053 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

F Xing ◽

J.I.N.G Li

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Clinical Outcomes ◽

Beta Blocker ◽

Beta Blockers ◽

Study Cohort ◽

Funding Source ◽

Proportional Hazard ◽

Cox Proportional Hazard ◽

All Cause Mortality

Abstract Background Heart failure (HF) is a leading cause of mortality and morbidity. Beta-blocker is recommended in HF with reduced ejection fraction (EF) in order to improve clinical outcomes. While the effects of beta-blockers in HF who have an EF greater than 40% are uncertain and controversial yet. Purpose To Investigate the associations between beta-blockers and clinical outcomes, overall and in strata of patients with an EF of between 40% and 49% or greater than 50%. Methods The study cohort included 2642 HF patients hospitalized primarily for HF who had an EF greater than 40%, which was from the China PEACE Prospective Heart Failure Study. We had two Clinical outcomes: 1-year all-cause mortality and 1-year hospitalization for HF after discharge. The associations between beta-blockers and clinical outcomes were assessed using Cox proportional hazard regression models, while stratified according to EF. Results The median age was 70 (IQR: 61, 77) years, 44.8% were women, EF was (median (IQR)) 54% (46%, 62%), and 55.5% received beta-blockers at discharge. All-cause mortality and hospitalizations for HF occurred in 341 (12.91%) and 636 (24.07%) patients respectively. In the Cox proportional hazard analysis, a significant interaction between EF and beta-blocker use for mortality was observed (P=0.01 for interaction). Stratified analysis showed beta-blockers reduced risks of mortality in patients who had an EF between 40% and 49% ((hazard ratios (HR): 0.501, 95% confidence interval (CI): 0.340- 0.738, p<0.001), but not among patients with an EF of 50% or greater (HR: 0.824, 95% CI: 0.600- 1.133, p=0.233). Use of β-blockers was not associated with reduced hospitalizations in patients with EF of between 40% and 49% and greater than 50% (HR: 1.016, 95% CI: 0.712- 1.450, p=0.931; HR: 0.905, 95% CI: 0.703- 1.166, p=0.439, respectively). Conclusion For patients with an EF between 40% and 49%, β-blocker use was associated with a reduced risk of all-cause mortality but not HF hospitalizations. For patients with an EF of 50% or greater, there was no such association. Funding Acknowledgement Type of funding source: Other. Main funding source(s): This work was supported by the National Key Research and Development Program (2017YFC1310803) from the Ministry of Science and Technology of China; the CAMS Innovation Fund for Medical Science (2017-I2M-B&R-02); the 111 Project from the Ministry of Education of China (B16005).

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