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Is heart rate a risk marker in patients with chronic heart failure and concomitant atrial fibrillation? Results from the MAGGIC meta‐analysis
Author(s) -
Simpson Joanne,
Castagno Davide,
Doughty Rob N.,
Poppe Katrina K.,
Earle Nikki,
Squire Iain,
Richards Mark,
Andersson Bert,
Ezekowitz Justin A.,
Komajda Michel,
Petrie Mark C.,
McAlister Finlay A.,
Gamble Greg D.,
Whalley Gillian A.,
McMurray John J.V.
Publication year - 2015
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1002/ejhf.346
Subject(s) - medicine , heart failure , cardiology , ejection fraction , atrial fibrillation , hazard ratio , heart rate , sinus rhythm , heart failure with preserved ejection fraction , proportional hazards model , ivabradine , blood pressure , confidence interval
Aim To investigate the relationship between heart rate and survival in patients with heart failure ( HF ) and coexisting atrial fibrillation ( AF ). Methods and Results Patients with AF included in the Meta‐analysis Global Group in Chronic Heart Failure ( MAGGIC ) meta‐analysis were the main focus of this analysis (3259 patients from 17 studies). The outcome was all‐cause mortality at 3 years. Heart rate was analysed as a categorical (tertiles; T1 ≤77 b.p.m., T2 78–98 b.p.m., T3 ≥98 b.p.m.) and continuous variable. Cox proportional hazard models were used to compare the risk of all‐cause death between tertiles of baseline heart rate. Patients in the highest tertile were more often female, less likely to have an ischaemic aetiology or diabetes, had a lower ejection fraction but higher blood pressure and New York Heart Association ( NYHA ) class. Higher heart rate was associated with higher mortality in patients with sinus rhythm ( SR ) but not in those in AF . In patients with heart failure and reduced ejection fraction ( HF‐REF ) and AF , death rates per 100 patient years were lowest in the highest heart rate tertile ( T1 18.9 vs. T3 15.9) but this difference was not statistically significant ( P = 0.10). In patients with heart failure and preserved ejection fraction ( HF‐PEF ), death rates per 100 patient years were highest in the highest heart rate tertile ( T1 14.6 vs. T3 16.0, P = 0.014). However, after adjustment for other important prognostic variables, higher heart rate was no longer associated with higher mortality in HF‐PEF (or HF‐REF ). Conclusions In this meta‐analysis of patients with HF , heart rate does not have the same prognostic significance in patients in AF as it does in those in SR , irrespective of ejection fraction or treatment with beta‐blocker.