Prognostic Significance of Heart Rate and Beta-Blocker Use in Sinus Rhythm in Patients with Heart Failure and Preserved Ejection Fraction.

Abstract

Prognostic significance of heart rate (HR) in heart failure with preserved ejection fraction (HFpEF) remains poorly understood. To evaluate the association of HR and beta-blocker use with all-cause mortality and the optimal HR range in patients with HFpEF and sinus rhythm (SR). During a follow-up of 2.7years (IQR 1.2-4.1years), the 330 patients with median age 73 (IQR 64-79) years, 52.1% men, were included. HFpEF was defined as patients with EF ≥ 50%. The outcome measure was all-cause mortality. In total, 96 (29.1%) of patients with HFpEF and SR died. A linear tendency between HR and mortality was observed in SR. Compared to the reference strata HR ≤ 60bpm, HR increment was associated with progressively increased risk in mortality (Chi-square = 13.90, Log rank P = 0.001) by Kaplan-Meier analyses. Univariate Cox regression showed that in SR, compared with that in HR 61-80bpm, the unadjusted hazard ratios for mortality were 0.41 (95% CI 0.23-0.74, P = 0.003) in HR ≤ 60bpm, 1.38 (95% CI 0.85-2.24, P = 0.189) in HR > 80bpm. Multivariate Cox regression showed that compared with that in HR 61-80bpm, the adjusted hazard ratios for mortality were 0.37 (95% CI 0.19-0.75, P = 0.005) in HR ≤ 60bpm, 0.96 (95% CI 0.52-1.74, P = 0.899) in HR > 80bpm. Univariate Cox regression showed that the unadjusted hazard ratios for mortality were 0.52 (95% CI 0.33-0.84, P =0.003) in patients with beta-blocker as compared patients without beta-blocker. Multivariate Cox regression showed that the adjusted hazard ratios for mortality were 0.48 (95% CI 0.26-0.87, P = 0.016) in patients with beta-blocker as compared patients without beta-blocker. HR is independently associated with increased all-cause mortality in SR and a lower HR (≤ 60bpm) is favorable for better outcome in HFpEF patients with SR. Beta-blocker use is associated with reduced mortality and a lower HR is associated with reduced mortality in HFpEF patients with SR.