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Prognostic Value of the Change in Heart Rate From the Supine to the Upright Position in Patients With Chronic Heart Failure

View Article: PubMed Central - PubMed

ABSTRACT

Background: The prognostic value of the change in heart rate from the supine to upright position (∆HR) in patients with chronic heart failure (HF) is unknown.

Methods and results: ∆HR was measured in patients enrolled in the Trial of Intensified Medical Therapy in Elderly Patients with Congestive Heart Failure (TIME‐CHF) who were in sinus rhythm and had no pacemaker throughout the trial (n=321). The impact of ∆HR on 18‐month outcome (HF hospitalization‐free survival) was assessed. In addition, the prognostic effect of changes in ∆HR between baseline and month 6 on outcomes in the following 12 months was determined. A lower ∆HR was associated with a higher risk of death or HF hospitalization (hazard ratio 1.79 [95% confidence interval {95% CI} 1.19‐2.75] if ∆HR ≤3 beats/min [bpm], P=0.004). In the multivariate analysis, lower ∆HR remained an independent predictor of death or HF hospitalization (hazard ratio 1.75 [95% CI, 1.18‐2.61] if ∆HR ≤3 bpm, P=0.004) along with ischemic HF etiology, lower estimated glomerular filtration rate, presence and extent of rales, and no baseline β‐blocker use. In patients without event during the first 6 months, the change in ∆HR from baseline to month 6 predicted death or HF hospitalization during the following 12 months (hazard ratio=2.13 [95% CI 1.12–5.00] if rise in ∆HR <2 bpm; P=0.027).

Conclusions: ∆HR as a simple bedside test is an independent prognostic predictor in patients with chronic HF. ∆HR is modifiable, and changes in ∆HR also provide prognostic information, which raises the possibility that ∆HR may help to guide treatment.

Clinical trial registration information: URL: www.isrctn.org. Unique identifier: ISRCTN43596477.

No MeSH data available.


Related in: MedlinePlus

Heart failure (HF) hospitalization‐free survival (A), survival (B), and hospitalization‐free survival (C) in patients with baseline ∆HR >3 bpm vs baseline ∆HR ≤3 bpm. CI indicates confidence interval.
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jah31684-fig-0001: Heart failure (HF) hospitalization‐free survival (A), survival (B), and hospitalization‐free survival (C) in patients with baseline ∆HR >3 bpm vs baseline ∆HR ≤3 bpm. CI indicates confidence interval.

Mentions: There were 100 (31%) patients who experienced the primary endpoint of HF hospitalization or death. There were 61 deaths (19%), and 187 (58%) patients experienced the endpoint of death or any hospitalization. When expressed as a continuous variable, a higher ∆HR was associated with a lower risk of death or HF hospitalization (hazard ratio 0.95 [95% CI 0.92‐0.99] per 1 bpm increase, P=0.01) and death (hazard ratio 0.95 [95% CI 0.90‐1.00] per 1 bpm increase, P=0.05). There was no significant association between ∆HR and all‐cause hospitalization or death (hazard ratio 0.98 [95% CI, 0.96‐1.01] per 1 bpm increase, P=0.25). The optimal threshold for ∆HR to identify subjects experiencing death or HF hospitalization was a ΔHR ≤3 bpm with only marginally less discriminative value for both ≤2 and ≤4 bpm (data not shown). As shown in Figure 1, patients with ∆HR ≤3 bpm had significantly worse HF hospitalization‐free survival, survival, and hospitalization‐free survival compared to those with ∆HR >3 bpm. Thus, in the following, patients with ΔHR ≤3 bpm and those with ΔHR >3 bpm are compared for descriptive purposes.


Prognostic Value of the Change in Heart Rate From the Supine to the Upright Position in Patients With Chronic Heart Failure
Heart failure (HF) hospitalization‐free survival (A), survival (B), and hospitalization‐free survival (C) in patients with baseline ∆HR >3 bpm vs baseline ∆HR ≤3 bpm. CI indicates confidence interval.
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Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5015278&req=5

jah31684-fig-0001: Heart failure (HF) hospitalization‐free survival (A), survival (B), and hospitalization‐free survival (C) in patients with baseline ∆HR >3 bpm vs baseline ∆HR ≤3 bpm. CI indicates confidence interval.
Mentions: There were 100 (31%) patients who experienced the primary endpoint of HF hospitalization or death. There were 61 deaths (19%), and 187 (58%) patients experienced the endpoint of death or any hospitalization. When expressed as a continuous variable, a higher ∆HR was associated with a lower risk of death or HF hospitalization (hazard ratio 0.95 [95% CI 0.92‐0.99] per 1 bpm increase, P=0.01) and death (hazard ratio 0.95 [95% CI 0.90‐1.00] per 1 bpm increase, P=0.05). There was no significant association between ∆HR and all‐cause hospitalization or death (hazard ratio 0.98 [95% CI, 0.96‐1.01] per 1 bpm increase, P=0.25). The optimal threshold for ∆HR to identify subjects experiencing death or HF hospitalization was a ΔHR ≤3 bpm with only marginally less discriminative value for both ≤2 and ≤4 bpm (data not shown). As shown in Figure 1, patients with ∆HR ≤3 bpm had significantly worse HF hospitalization‐free survival, survival, and hospitalization‐free survival compared to those with ∆HR >3 bpm. Thus, in the following, patients with ΔHR ≤3 bpm and those with ΔHR >3 bpm are compared for descriptive purposes.

View Article: PubMed Central - PubMed

ABSTRACT

Background: The prognostic value of the change in heart rate from the supine to upright position (∆HR) in patients with chronic heart failure (HF) is unknown.

Methods and results: ∆HR was measured in patients enrolled in the Trial of Intensified Medical Therapy in Elderly Patients with Congestive Heart Failure (TIME‐CHF) who were in sinus rhythm and had no pacemaker throughout the trial (n=321). The impact of ∆HR on 18‐month outcome (HF hospitalization‐free survival) was assessed. In addition, the prognostic effect of changes in ∆HR between baseline and month 6 on outcomes in the following 12 months was determined. A lower ∆HR was associated with a higher risk of death or HF hospitalization (hazard ratio 1.79 [95% confidence interval {95% CI} 1.19‐2.75] if ∆HR ≤3 beats/min [bpm], P=0.004). In the multivariate analysis, lower ∆HR remained an independent predictor of death or HF hospitalization (hazard ratio 1.75 [95% CI, 1.18‐2.61] if ∆HR ≤3 bpm, P=0.004) along with ischemic HF etiology, lower estimated glomerular filtration rate, presence and extent of rales, and no baseline β‐blocker use. In patients without event during the first 6 months, the change in ∆HR from baseline to month 6 predicted death or HF hospitalization during the following 12 months (hazard ratio=2.13 [95% CI 1.12–5.00] if rise in ∆HR <2 bpm; P=0.027).

Conclusions: ∆HR as a simple bedside test is an independent prognostic predictor in patients with chronic HF. ∆HR is modifiable, and changes in ∆HR also provide prognostic information, which raises the possibility that ∆HR may help to guide treatment.

Clinical trial registration information: URL: www.isrctn.org. Unique identifier: ISRCTN43596477.

No MeSH data available.


Related in: MedlinePlus