Associations between baseline heart rate and blood pressure and time to events in HFrEF patients: data from the QUALIFY international registry.

Abstract

A high resting heart rate (RHR) and low systolic blood pressure (SBP) are a risk factor and a risk indicator, respectively, for poor heart failure (HF) outcomes. This analysis evaluates the associations between baseline RHR and SBP with outcomes and treatment patterns in HF patients with reduced ejection fraction (HFrEF) in the QUALIFY international registry. Between September 2013 and December 2014, 7317 HFrEF patients with a previous HF hospitalization within 1-15 months were enrolled in the QUALIFY registry (Quality of Adherence to Guideline Recommendations for Life-Saving Treatment in Heart Failure Survey). Complete follow-up data were available for 5138 patients. The relationships between RHR and SBP and outcomes were assessed using a Cox proportional hazards model and were analyzed according to baseline values as high RHR (H-RHR) ≥ 75 vs. low RHR (L-RHR) < 75 bpm) and high SBP (H-SBP): ≥ 110 vs. low SBP (L-SBP): <110 mmHg and analyzed according to each of the following 4 phenotypes: (H-RHR/L-SBP, L-RHR/L-SBP, H-RHR/H-SBP and L-RHR/H-SBP (reference group). Compared to the reference group, H-RHR/L-SBP was associated with the worst outcomes for the combined primary endpoint of CV death and HF hospitalization (HR 1.83, CI 1.51-2.21, p<0.001), CV death (HR 2.7, CI 1.69-4.33, p <0.001), and HF hospitalization (HR 1.62, CI 1.30-2.01, p<0.001). Low-risk patients with L-RHR/H-SBP achieved more frequently >=50% of target doses of ACEIs and BBs than the other groups. However, 48% and 46% of low-risk patients were not well treated with ACEIs and BBs, respectively (<=50% of target dose or no treatment). In patients with HFrEF and recent hospitalisation, elevated RHR and lower SBP identify patients at increased risk for CV endpoints. While SBP and RHR are often recognized as barriers that deter physicians from treating with high doses of recommended drugs, they are not the only reason leaving many patients suboptimally treated. This article is protected by copyright. All rights reserved.