TY - JOUR
T1 - Prognostic Importance of Temporal Changes in Resting Heart Rate in Heart Failure and Preserved Ejection Fraction
T2 - From the TOPCAT Study
AU - Vazir, Ali
AU - Claggett, Brian
AU - Pitt, Bertram
AU - Anand, Inder
AU - Sweitzer, Nancy
AU - Fang, James
AU - Fleg, Jerome
AU - Rouleau, Jean
AU - Shah, Sanjiv
AU - Pfeffer, Marc A.
AU - Solomon, Scott D.
PY - 2017/11
Y1 - 2017/11
N2 - Objectives The aim of this study was to examine the relationship between baseline heart rate (HR), change in HR from a preceding visit, and time-updated HR with subsequent outcomes in patients with heart failure with preserved ejection fraction (HFpEF) in the TOPCAT (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist) trial. Background Higher resting HR and increase in HR over time in patients with heart failure are associated with adverse outcomes. Whether these relationships between HR and prognosis are also observed in patients with HFpEF requires further assessment. Methods In 1,767 patients enrolled in the TOPCAT trial from the Americas, the associations between baseline resting HR and change in HR from the preceding visit and clinical outcomes were examined using Cox proportional hazards models, along with the association between HR at each visit and outcome. Results Both baseline HR (adjusted hazard ratio: 1.08; 95% confidence interval: 1.04 to 1.12) and change in HR from the preceding visit (adjusted hazard ratio: 1.09; 95% confidence interval: 1.05 to 1.14; p < 0.001 per 5 beats/min higher HR), after adjusting for covariates, were associated with a higher risk for the primary endpoint of cardiovascular death, hospitalization for HF, or aborted cardiac arrest. Time-updated resting HR at each visit was also associated with risk (adjusted hazard ratio: 1.11; 95% confidence interval: 1.07 to 1.15; p < 0.001 per 5 beats/min higher HR). Furthermore, a rise in resting HR of approximately 10 beats/min, beginning approximately 10 days prior to the primary endpoint, was observed. Conclusions Baseline resting HR and change in HR over time predict outcomes in patients with HFpEF, as does time-updated HR during follow-up. These data suggest that frequent outpatient monitoring of HR, possibly with remote technologies, may identify patients with HFpEF who may be at increased risk for rehospitalization or death.
AB - Objectives The aim of this study was to examine the relationship between baseline heart rate (HR), change in HR from a preceding visit, and time-updated HR with subsequent outcomes in patients with heart failure with preserved ejection fraction (HFpEF) in the TOPCAT (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist) trial. Background Higher resting HR and increase in HR over time in patients with heart failure are associated with adverse outcomes. Whether these relationships between HR and prognosis are also observed in patients with HFpEF requires further assessment. Methods In 1,767 patients enrolled in the TOPCAT trial from the Americas, the associations between baseline resting HR and change in HR from the preceding visit and clinical outcomes were examined using Cox proportional hazards models, along with the association between HR at each visit and outcome. Results Both baseline HR (adjusted hazard ratio: 1.08; 95% confidence interval: 1.04 to 1.12) and change in HR from the preceding visit (adjusted hazard ratio: 1.09; 95% confidence interval: 1.05 to 1.14; p < 0.001 per 5 beats/min higher HR), after adjusting for covariates, were associated with a higher risk for the primary endpoint of cardiovascular death, hospitalization for HF, or aborted cardiac arrest. Time-updated resting HR at each visit was also associated with risk (adjusted hazard ratio: 1.11; 95% confidence interval: 1.07 to 1.15; p < 0.001 per 5 beats/min higher HR). Furthermore, a rise in resting HR of approximately 10 beats/min, beginning approximately 10 days prior to the primary endpoint, was observed. Conclusions Baseline resting HR and change in HR over time predict outcomes in patients with HFpEF, as does time-updated HR during follow-up. These data suggest that frequent outpatient monitoring of HR, possibly with remote technologies, may identify patients with HFpEF who may be at increased risk for rehospitalization or death.
KW - heart failure
KW - heart rate
KW - outcome research
UR - http://www.scopus.com/inward/record.url?scp=85030870833&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85030870833&partnerID=8YFLogxK
U2 - 10.1016/j.jchf.2017.08.018
DO - 10.1016/j.jchf.2017.08.018
M3 - Article
C2 - 29032132
AN - SCOPUS:85030870833
SN - 2213-1779
VL - 5
SP - 782
EP - 791
JO - JACC: Heart Failure
JF - JACC: Heart Failure
IS - 11
ER -