Introduction: The impact of discharge heart rate on the prognosis of heart failure with reduced left ventricular ejection fraction (LVEF) had been described. On the other hand, the association of discharge heart rate with heart failure with preserved LVEF has not been fully evaluated.
Methods: WET-HF Registry is a multicenter, prospective cohort registry enrolling all patients requiring hospitalization for acute decompensated heart failure. In this study, 3545 patients were enrolled from June 2005 through March 2017. Discharge heart rate was categorized into quartile: <61, 61-70, 71-80, >80. Endpoint was all-cause mortality. Cox-regression analysis was used to study the association of discharge heart rate with mortality.
Results: Median age was 77 years and median discharge heart rate was 70 beats per minute (bpm). There was a significant increase in all-cause mortality in sinus rhythm with adjusted odds ratios of 2.490 (95% confidence interval [CI], 1.579-3.925; P<0.001) for discharge heart rates >80 compared with the reference group (heart rates, <61 bpm). However, in atrial fibrillation patients, there was no significant difference. Among those with preserved LVEF (>50%), there was the trend of the low odds of all-cause mortality compared with the patients with reduced LVEF (<40%): adjusted odds ratio 2.145 (discharge heart rates, >80 bpm; 95% CI, 0.987-4.661; P=0.054) in LVEF (>50%) and 3.658 (discharge heart rates, >80 bpm; 95% CI, 1.688-7.927; P=0.001) in LVEF (<40%). Among the patients of >80 heart rate who were not prescribed a β-adrenoreceptor antagonist, there was a significant increase in mortality with adjusted odds ratios of 11.165 (95% confidence interval [CI], 2.475-50.362; P=0.002) compared with the reference group.
Conclusions: Higher heart rates at hospital discharge were associated with increased risk of all-cause mortality and there was the trend of lower risk in preserved LVEF than in reduced LVEF in Japanese acute heart failure patients.