Abstract 12149: Prognostic Benefit of Heart Rate Reduction of Hospitalized Heart Failure Patients is Different Between Atrial Fibrillation and Sinus Rhythm

Abstract

Introduction: Heart rate (HR) reduction is a key strategy for improving clinical prognosis of patients with heart failure (HF) regardless of presenting atrial fibrillation (AF) or sinus rhythm (SR). However, the prognostic impact of HR reduction during hospitalization is still unclear. Hypothesis: The degree of HR reduction during hospitalization between HF patients with AF and SR differently contributes to the prognosis after discharge. Methods: This observational study included 1,930 hospitalized HF patients who were discharged alive. After excluding patients who were implanted pacing devices, those presenting paroxysmal AF, and those with missing data of HR, 1,137 patients were ultimately analyzed. Of them, 456 patients presented AF and 681 presented SR at admission. Change of HR was defined as the difference between HR at admission and discharge. We evaluated the association between in-hospital HR change and the incidence of a composite of cardiovascular death after discharge and HF re-hospitalization in patients with AF and SR, respectively. Results: During the observation period (median 528 (IQR: 135-736) days), the composite endpoint developed in 169 (37%) and 187 (27%) patients with AF and SR, respectively. The ROC curves for the composite endpoint showed the cut-off values of HR reduction were 0 bpm and 28 bpm in patients with AF and SR, respectively. Kaplan-Meier analysis showed a significantly lower incidence of a composite endpoint in patients who achieved HR reduction greater than the cut-off value in both groups (log-rank test: p<0.05). HR reduction greater than the cut-off value was still an independent predictor for a composite endpoint in patients with AF after adjusting age, sex, HR at admission and LVEF (hazard ratio: 0.65, 95% confidence interval: 0.45-0.96). However, this finding was not observed in patients with SR (hazard ratio: 0.81, 95% confidence interval: 0.50-1.33). Conclusions: The ideal HR reduction level during hospitalization was different between AF and SR. Target HR reduction in HF patients with AF could lead to better clinical outcomes, but the benefit is limited in patients with SR.