19 Elevated heart rate in recently stabilised heart failure patients and long term cardiac outcomes

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Abstract

Background

Previous studies have shown that in acute heart failure, elevated heart rate (HR) on acute admission or on discharge is associated with increased short-medium term mortality and morbidity. In chronic heart failure, elevated HR is also associated with adverse outcome. The purpose of this study was (a) to evaluate heart rates in recently stabilised patients at the time of first outpatient review, 1–2 months following heart failure admission and (b) to assess if elevated heart rate at this time point continued to predict adverse outcome over long term follow up.

Methods

All patient records presenting to the heart failure service in our Centre between July 2011 and June 2013 were assessed. Inclusion criteria were patients with left ventricular ejection fraction ≤40% on echo, outpatient attendance ≤8 weeks post discharge, in sinus rhythm, and in whom resting HR was recorded. Patients in atrial fibrillation at presentation were excluded. Elevated HR was defined as ≥70 beats per minute (bpm). The incidence of readmission for heart failure, acute coronary syndrome (ACS), and death was determined from clinical records with a minimum follow up of three years. Fisher’s Exact Test and Student’s t-test were used to determine statistical significance.

Results

Of 235 patients presenting to the heart failure service between July 2011 and June 2013, 87 (37%) met inclusion criteria. Over half were >70 years of age, 57% were male, and 69% had an ischaemic cardiomyopathy. Mean HR was 69 bpm. Patients were followed for up to 5 years (mean 3.4 years, range 3.2–5 years). Readmission for heart failure occurred in 10 patients, ACS in 7 patients and death in 23 patients. Those with HR≥70 bpm compared to those with HR<70 bpm died at a younger age (mean 70 vs 82 years; p=0.0024), were more likely to die before mean life expectancy of 81 years (92% vs 27% p=0.0028), and had a trend to increased incidence of premature death (defined as death <75 years) (58% vs 18%; p=0.089). There was no significant difference in readmissions for heart failure or ACS between the two heart rate groups.

Conclusions

In this study of recently stabilised patients managed by a single heart failure team, in consistent fashion and according to a standardised protocol, those with elevated HR≥70 were less likely to reach mean life expectancy and had a trend to premature death.

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