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Repeated heart rate measurement and cardiovascular outcomes in left ventricular systolic dysfunction
Victoria Hamill1, Ian Ford1, Kim Fox2
1Robertson Centre for Biostatistics, University of Glasgow, Glasgow, United Kingdom.
Insights
Routine heart rate monitoring in patients with left ventricular systolic dysfunction improves cardiovascular risk assessment. Time-updated heart rate measurements offer stronger prognostic value than baseline heart rate for adverse outcomes.
Area of Science:
- Cardiology
- Clinical Trials
- Heart Failure Research
Background:
- Elevated resting heart rate (RHR) correlates with increased cardiovascular risk, especially in patients with left ventricular systolic dysfunction (LVSD).
- RHR is not routinely monitored in LVSD patients, potentially limiting its prognostic utility.
- This study investigated if routine heart rate monitoring enhances prognostic value in LVSD.
Purpose of the Study:
- To evaluate the prognostic value of baseline and time-updated heart rate in patients with LVSD.
- To determine if routine heart rate monitoring improves cardiovascular risk prediction in this population.
Main Methods:
- Pooled data from placebo groups of the BEAUTIFUL and SHIFT trials (patients with LVSD).
- Analyzed heart rate measurements (baseline and time-updated) against adverse cardiovascular outcomes using Cox proportional hazards models.
- Adjusted for prognostic factors and compared baseline vs. time-updated heart rate predictions.
Main Results:
- Baseline heart rate strongly predicted most adverse outcomes, except myocardial infarction hospitalization.
- Time-updated heart rate demonstrated stronger associations with all adverse outcomes.
- A 5 beats/min increase in time-updated heart rate correlated with a 22% higher risk of heart failure hospitalization, exceeding baseline HR's 15% increase.
Conclusions:
- Time-updated heart rate is a more potent predictor of adverse cardiovascular events than baseline heart rate in LVSD patients.
- Regular heart rate measurement at all patient assessments is recommended for comprehensive cardiovascular risk evaluation in LVSD.
Background:
Elevated resting heart rate is associated with increased cardiovascular risk, particularly in patients with left ventricular systolic dysfunction. Heart rate is not monitored routinely in these patients. We hypothesized that routine monitoring of heart rate would increase its prognostic value in patients with left ventricular systolic dysfunction.
Methods:
We analyzed the relationship between heart rate measurements and a range of adverse cardiovascular outcomes, including hospitalization for worsening heart failure, in the pooled placebo-treated patients from the morBidity-mortality EvAlUaTion of the If inhibitor ivabradine in patients with coronary disease and left ventricULar dysfunction (BEAUTIFUL) trial and Systolic Heart failure treatment with the If inhibitor ivabradine (SHIFT) Trial, using standard and time-varying covariate Cox proportional hazards models. By adjusting for other prognostic factors, models were fitted for baseline heart rate alone or for time-updated heart rate (latest heart rate) alone or corrected for baseline heart rate or for immediate previous time-updated heart rate.
Results:
Baseline heart rate was strongly associated with all outcomes apart from hospitalization for myocardial infarction. Time-updated heart rate increased the strengths of associations for all outcomes. Adjustment for baseline heart rate or immediate previous time-updated heart rate modestly reduced the prognostic importance of time-updated heart rate. For hospitalization for worsening heart failure, each 5 beats/min increase in baseline heart rate and time-updated heart rate was associated with a 15% (95% confidence interval, 12-18) and 22% (confidence interval, 19-40) increase in risk, respectively. Even after correction, the prognostic value of time-updated heart rate remained greater.
Conclusions:
In patients with left ventricular systolic dysfunction, time-updated heart rate is more strongly related with adverse cardiovascular outcomes than baseline heart rate. Heart rate should be measured to assess cardiovascular risk at all assessments of patients with left ventricular systolic dysfunction.
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