Different impact of elevated heart rate on cardiovascular events between heart failure with reduced ejection fraction and preserved ejection fraction - a report from the CHART-2 study

Abstract

Purpose: It is still controversial whether elevated baseline heart rate (HR) is associated with higher mortality in patients with heart failure (HF) with preserved ejection fraction (HFpEF). We compared the prognostic impact of baseline HR between patients with HFpEF and those with HF with reduced ejection fraction (HFrEF). Methods and results: We enrolled consecutive 2,688 patients with symptomatic Stage C/D HF with sinus rhythm from our Chronic Heart Failure Analysis and Registry in the Tohoku District 2 (CHART-2) Study (n=10,219). The prognostic impact of HR increase was compared between HFrEF (LVEF 50%, n=1,803). Cox regression analysis revealed that elevated baseline HR was significantly associated with increased all-cause mortality in both groups (hazard ratio for the highest tertile (HH) 1.77 in HFrEF, P=0.008; HH1.82 in HFpEF, P=0.001) (Figure 1). However, elevated HR was significantly associated with cardiovascular (CV) death in HFpEF (HH 2.17, P=0.012) but not in HFrEF (HH1.49, P=0.14). Furthermore, the impact of elevated HR on HF death was different between HFpEF (HH 3.79, P=0.020) and HFrEF (HH 1.07, P=0.864). This was also the case for CV death in patients without β-blocker therapy in both HFpEF (HH 2.89, P=0.013) and HFrEF (HH 2.07, P=0.131). Furthermore, β-blocker therapy was significantly associated with reduced HF mortality in HFrEF (hazard ratio 0.51, P=0.041) but not in HFpEF (hazard ratio 0.59, P=0.243). ![Figure][1] Figure 1 Conclusions: These results indicate that elevated HR is associated with increased CV death, particularly HF death, in HFpEF compared with HFrEF, whereas its impact on all-cause mortality is comparable between the 2 groups. They also suggest that β-blocker therapy is associated with improved HF mortality in HFrEF but not in HFpEF. [1]: pending:yes