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Prognostic Importance of Temporal Changes in Resting Heart Rate in Heart Failure and Preserved Ejection Fraction:
Ali Vazir1, Brian Claggett2, Bertram Pitt3
1Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Massachusetts; Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust and Institute of Cardiovascular Medicine and Sciences, National Heart and Lung Institute, Imperial College London, London, United Kingdom.
Insights
Higher heart rate (HR) and increasing HR over time are linked to worse outcomes in heart failure with preserved ejection fraction (HFpEF) patients. Frequent HR monitoring may identify high-risk individuals.
Area of Science:
- Cardiology
- Clinical Trials
- Heart Failure Research
Background:
- Elevated resting heart rate (HR) and HR increases are linked to adverse outcomes in heart failure.
- The prognostic significance of HR in heart failure with preserved ejection fraction (HFpEF) requires further investigation.
Purpose of the Study:
- To investigate the association between baseline HR, HR changes, and time-updated HR with clinical outcomes in HFpEF patients.
- To analyze HR patterns in relation to cardiovascular death, HF hospitalization, or aborted cardiac arrest within the TOPCAT trial.
Main Methods:
- Analysis of 1,767 HFpEF patients from the TOPCAT trial (Americas cohort).
- Utilized Cox proportional hazards models to assess baseline HR, HR change from prior visits, and time-updated HR.
- Examined the relationship between HR metrics and the primary composite endpoint.
Main Results:
- Both higher baseline HR (aHR: 1.08) and increased HR over time (aHR: 1.09 per 5 bpm increase) were associated with increased risk.
- Time-updated HR also predicted risk (aHR: 1.11 per 5 bpm increase).
- A rise of ~10 bpm in HR preceding the endpoint by ~10 days was observed.
Conclusions:
- Baseline HR, HR changes, and time-updated HR are significant predictors of outcomes in HFpEF.
- Suggests frequent HR monitoring, potentially via remote technology, can identify high-risk HFpEF patients for intervention.
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.