Lower Heart Rate Associated With Improved Outcomes in Heart Failure With Preserved Ejection Fraction

Abstract

Background: Although a lower heart rate (HR) has been associated with im- proved outcomes in patients with heart failure and reduced ejection fraction, the evidence in patients with heart failure with preserved ejection fraction (HFpEF) is contradictory. Pathophysiologic studies have shown longer heart rate recovery times after exercise in patients with HFpEF. This data may suggest that the inhibtory effect beta-blockers have on chronotropic drive could lead to a detrimental effect. The aim of this study was to evaluate effects of HR in pa- tients with HFpEF with respect to death and heart failure hospitalizations (HFH). Methods: 81 patients with HFpEF were included in this analysis. Patients were stratified into 3 groups based on heart rates at diagnosis: Group 1 HR !60 beats per minute (bpm), group 2561-90 bpm and group 3 O91 bpm. The combined out- come of HFH and death was analyzed in these 3 groups using Kaplan Meier Sur- vival analysis and multivariable Cox regression analysis. Results: 97.5% were male with mean age 71 6 9 years, EF556.3 6 5% and 53% NYHA class III. At one year, 9% group 1, 26% group 2 and 29% group 3 reached the combined end- point (p50.22, see figure). By multivariate analysis, the combined outcome at one year was not significantly different in the three groups (p50.21). Of note, absence of beta blocker use was associated with worse outcome with a hazard ratio of 3.9 (p50.02). Conclusion: In patients with HFpEF, HR at diagnosis does not predict outcome in a predominantly male population. However, recent data has suggested HR may predict an improved prognosis in a more heterogenous population of pa- tients with HFpEF. Effect of beta blocker use was not clearly analyzed in that par- ticular study. Interestingly, beta-blocker use appears to be protective in our patient population.