Open AccessHeart rate and outcome in heart failure with reduced ejection fraction: Differences between atrial fibrillation and sinus rhythm—A CIBIS II analysis
Author(s) -
Mulder Bart A.,
Damman Kevin,
Van Veldhuisen Dirk J.,
Van Gelder Isabelle C.,
Rienstra Michiel
Publication year - 2017
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.22725
Subject(s) - medicine , cardiology , atrial fibrillation , sinus rhythm , hazard ratio , ejection fraction , heart failure , heart rate , quartile , confidence interval , blood pressure
Background Heart rate has been associated with prognosis in patients with heart failure with reduced ejection fraction ( HFREF ) and sinus rhythm; whether this also holds true in patients with atrial fibrillation ( AF ) is unknown. Hypothesis To evaluate cardiac rhythm and baseline heart rate and the influence of outcome in patients with HFREF enrolled in the Cardiac Insufficiency Bisoprolol Study II. Methods In total, 2539 patients were stratified according to their baseline heart rhythm ( AF or sinus rhythm) and into quartiles of heart rate (≤70 bpm, 71–78 bpm, 79–90 bpm, and >90 bpm). The primary outcome was all‐cause mortality. Mean follow‐up was 1.3 years. Results Mean age was 61 years, mean left ventricular ejection fraction was 28%, and 80% were male. A total of 521 (21%) patients had AF at baseline. The risk associated with all‐cause mortality for each 5 bpm increase in heart rate in patients with sinus rhythm (hazard ratio [ HR ]: 1.06, 95% confidence interval [ CI ]: 1.01‐1.11, P = 0.012) was significantly different from those with AF ( HR : 1.00, 95% CI : 0.94‐1.07, P = 0.90, P for interaction = 0.041). The risk associated with higher heart rate in sinus rhythm was primarily attributable to excess risk in the highest quartile ( HR : 1.64, 95% CI : 1.18–2.30, P = 0.003). Allocation to bisoprolol did not modify the interaction between heart rate, rhythm and outcome. Conclusions In HFREF patients with AF , a higher heart rate is not associated with increased event rates in contrast to HFREF patients with sinus rhythm.