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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.


HF hospitalization‐free survival according to the change in ΔHR from baseline to month 6 (Change0→6∆HR; <2 bpm vs ≥2 bpm) after month 6.
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jah31684-fig-0003: HF hospitalization‐free survival according to the change in ΔHR from baseline to month 6 (Change0→6∆HR; <2 bpm vs ≥2 bpm) after month 6.

Mentions: There were 229 patients alive at 6 months and without HF hospitalization during the first 6 months who had available data on ∆HR at baseline and month 6. The mean change in ∆HR from baseline at month 6 was 0±9 bpm (P=0.57 for overall comparison baseline vs month 6). There were 107 patients with a decrease in ∆HR, 27 patients with unchanged ∆HR, and 95 patients with an increase in ∆HR. A more positive change in ∆HR from baseline to month 6 was not significantly associated with a lower risk of HF hospitalization or death (hazard ratio 0.96 [95% CI, 0.92‐1.002] per 1 bpm increase; P=0.07), but patients with an increase in ∆HR from baseline to month 6 by <2 bpm (optimal cutoff; n=138) had a significantly higher risk of HF hospitalization or death than those with an increase in ∆HR from baseline to month 6 by ≥2 bpm (n=91; hazard ratio 2.13 [95% CI 1.12‐5.00]; P=0.027; Figure 3).


Prognostic Value of the Change in Heart Rate From the Supine to the Upright Position in Patients With Chronic Heart Failure
HF hospitalization‐free survival according to the change in ΔHR from baseline to month 6 (Change0→6∆HR; <2 bpm vs ≥2 bpm) after month 6.
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Related In: Results  -  Collection

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

jah31684-fig-0003: HF hospitalization‐free survival according to the change in ΔHR from baseline to month 6 (Change0→6∆HR; <2 bpm vs ≥2 bpm) after month 6.
Mentions: There were 229 patients alive at 6 months and without HF hospitalization during the first 6 months who had available data on ∆HR at baseline and month 6. The mean change in ∆HR from baseline at month 6 was 0±9 bpm (P=0.57 for overall comparison baseline vs month 6). There were 107 patients with a decrease in ∆HR, 27 patients with unchanged ∆HR, and 95 patients with an increase in ∆HR. A more positive change in ∆HR from baseline to month 6 was not significantly associated with a lower risk of HF hospitalization or death (hazard ratio 0.96 [95% CI, 0.92‐1.002] per 1 bpm increase; P=0.07), but patients with an increase in ∆HR from baseline to month 6 by <2 bpm (optimal cutoff; n=138) had a significantly higher risk of HF hospitalization or death than those with an increase in ∆HR from baseline to month 6 by ≥2 bpm (n=91; hazard ratio 2.13 [95% CI 1.12‐5.00]; P=0.027; Figure 3).

View Article: PubMed Central - PubMed

ABSTRACT

Background: The prognostic value of the change in heart rate from the supine to upright position (&#8710;HR) in patients with chronic heart failure (HF) is unknown.

Methods and results: &#8710;HR was measured in patients enrolled in the Trial of Intensified Medical Therapy in Elderly Patients with Congestive Heart Failure (TIME&#8208;CHF) who were in sinus rhythm and had no pacemaker throughout the trial (n=321). The impact of &#8710;HR on 18&#8208;month outcome (HF hospitalization&#8208;free survival) was assessed. In addition, the prognostic effect of changes in &#8710;HR between baseline and month 6 on outcomes in the following 12&nbsp;months was determined. A lower &#8710;HR was associated with a higher risk of death or HF hospitalization (hazard ratio 1.79 [95% confidence interval {95% CI} 1.19&#8208;2.75] if &#8710;HR &le;3&nbsp;beats/min [bpm], P=0.004). In the multivariate analysis, lower &#8710;HR remained an independent predictor of death or HF hospitalization (hazard ratio 1.75 [95% CI, 1.18&#8208;2.61] if &#8710;HR &le;3&nbsp;bpm, P=0.004) along with ischemic HF etiology, lower estimated glomerular filtration rate, presence and extent of rales, and no baseline &beta;&#8208;blocker use. In patients without event during the first 6&nbsp;months, the change in &#8710;HR from baseline to month 6 predicted death or HF hospitalization during the following 12&nbsp;months (hazard ratio=2.13 [95% CI 1.12&ndash;5.00] if rise in &#8710;HR &lt;2&nbsp;bpm; P=0.027).

Conclusions: &#8710;HR as a simple bedside test is an independent prognostic predictor in patients with chronic HF. &#8710;HR is modifiable, and changes in &#8710;HR also provide prognostic information, which raises the possibility that &#8710;HR may help to guide treatment.

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

No MeSH data available.