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LAD-Ligation: A Murine Model of Myocardial Infarction
Published on: October 14, 2009
Discharge Heart Rate After Hospitalization for Myocardial Infarction and Long-Term Mortality in 2 US Registries
Venkatesh Alapati1, Fengming Tang2, Esti Charlap3
11 New York-Presbyterian Brooklyn Methodist Hospital Brooklyn NY.
Insights
Higher discharge heart rate after acute myocardial infarction (AMI) independently predicts increased long-term mortality. Beta-blocker use at discharge modifies this risk, highlighting potential interventions for AMI survivors.
Area of Science:
- Cardiology
- Clinical Research
- Outcomes Research
Background:
- Admission heart rate is a known predictor of mortality post-acute myocardial infarction (AMI).
- Limited data exists regarding the prognostic value of discharge heart rate following AMI.
- Understanding discharge heart rate's impact is crucial for refining risk stratification and treatment strategies.
Purpose of the Study:
- To investigate the association between discharge heart rate and long-term mortality after AMI.
- To compare the predictive power of discharge heart rate versus admission heart rate on mortality.
- To determine if beta-blocker therapy modifies the relationship between discharge heart rate and mortality.
Main Methods:
- Analysis of 2 prospective US multicenter registries of acute myocardial infarction (AMI) patients.
- Evaluation of associations between admission and discharge heart rates with 3-year mortality using Cox proportional hazards models.
- Adjustment for demographic, psychosocial, and clinical covariates, including infarct severity and comorbidities.
Main Results:
- Discharge heart rate was independently associated with increased 3-year mortality (HR=1.14 per 10 bpm), more strongly than admission heart rate (HR=1.05 per 10 bpm).
- A significant interaction was observed between discharge heart rate and beta-blocker use (P=0.004).
- Patients with high discharge heart rate not on beta-blockers had markedly higher mortality risk (HR=1.35 per 10 bpm) compared to those on beta-blockers (HR=1.10 per 10 bpm).
Conclusions:
- Elevated discharge heart rate post-AMI is a significant independent predictor of 3-year mortality.
- Beta-blocker therapy at discharge mitigates the increased mortality risk associated with higher discharge heart rates.
- These findings suggest discharge heart rate and beta-blocker status are important factors for risk stratification and potential therapeutic intervention in AMI patients.
Abstract:
Background Although admission heart rate predicts higher mortality after acute myocardial infarction ( AMI ), less is known about discharge heart rate. We tested the hypothesis that higher discharge heart rate after AMI is related to increased long-term mortality independent of admission heart rate, and assessed whether β blockers modify this relationship. Methods and Results In 2 prospective US multicenter registries of AMI , we evaluated the associations of discharge and admission heart rate with 3-year mortality using Cox models. Among 6576 patients with AMI , discharge heart rate was modestly associated with initial heart rate ( r=0.28), comorbidities, and infarct severity. In this cohort, 10.7% did not receive β blockers at discharge. After full adjustment for demographic, psychosocial, and clinical covariates, discharge heart rate (hazard ratio [HR]=1.14 per 10 beats per minute [bpm]; 95% CI =1.07-1.21 per 10 bpm) was more strongly associated with risk of death than admission heart rate (HR=1.05 per 10 bpm; 95% CI=1.02-1.09 per 10 bpm) when both were entered in the same model ( P=0.043 for comparison). There was a significant interaction between discharge heart rate and β-blocker use ( P=0.004) on mortality, wherein risk of death was markedly higher among those with high discharge heart rate and not on β blockers (HR=1.35 per 10 bpm; 95% CI=1.19-1.53 per 10 bpm) versus those with a high discharge heart rate and on β blockers at discharge (HR=1.10 per 10 bpm; 95% CI=1.03-1.17 per 10 bpm). Conclusions Higher discharge heart rate after AMI was more strongly associated with 3-year mortality than admission heart rate, and the risk associated with higher discharge heart rate was modified by β blockers at discharge. These findings highlight opportunities for risk stratification and intervention that will require further investigation.
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