title: Association of heart rate at hospital discharge with mortality and hospitalizations in patients with heart failure.
abstract: BACKGROUND
  Heart failure (HF) is associated with a high burden of morbidity and mortality. Hospital discharge is an opportunity for identification of modifiable prognostic factors in the transition to chronic HF.
  
  
  RESULTS
  We examined the association of discharge heart rate with 30-day and 1-year mortality and hospitalization outcomes in a cohort of 9097 patients with HF discharged from hospital. Discharge heart rate was categorized into predefined groups: 40 to 60 (n=1333), 61 to 70 (n=2170), 71 to 80 (n=2631), 81 to 90 (n=1700), and >90 bpm (n=1263). There was a significant increase in all-cause 30-day mortality with adjusted odds ratios of 1.59 (95% confidence interval [CI], 1.18-2.14; P=0.003) for discharge heart rates 81 to 90 bpm and 1.56 (95% CI, 1.13-2.16; P=0.007) for heart rates>90 bpm when compared with the reference group (heart rates, 61-70 bpm). Cardiovascular death risk at 30 days was also higher with adjusted odds ratio 1.59 (discharge heart rates, 81-90 bpm; 95% CI, 1.09-2.33; P=0.017) and 1.65 (discharge heart rates, >90 bpm; 95% CI, 1.09-2.48; P=0.017). One-year all-cause mortality (adjusted odds ratio, 1.41; 95% CI, 1.16-1.72; P<0.001) and cardiovascular death (adjusted odds ratio, 1.47; 95% CI, 1.12-1.92; P=0.005) were higher with discharge heart rates>90 bpm when compared with the reference group (heart rates, 40-60 bpm). Readmissions for HF (adjusted hazard ratio, 1.26; 95% CI, 1.04-1.54; P=0.021) and cardiovascular disease (adjusted hazard ratio, 1.29; 95% CI, 1.08-1.54; P=0.004) within 30 days were also higher with discharge heart rates>90 bpm.
  
  
  CONCLUSIONS
  Higher discharge heart rates were associated with greater risk of all-cause and cardiovascular mortality≤1-year follow-up and an elevated risk of 30-day readmission for HF and cardiovascular disease.
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Canada.
authors.forename: Marlena V
authors.initials: MV
authors.lastname: Habal
authors.forename: Peter P
authors.initials: PP
authors.lastname: Liu
authors.forename: Peter C
authors.initials: PC
authors.lastname: Austin
authors.forename: Heather J
authors.initials: HJ
authors.lastname: Ross
authors.forename: Gary E
authors.initials: GE
authors.lastname: Newton
authors.forename: Xuesong
authors.initials: X
authors.lastname: Wang
authors.forename: Jack V
authors.initials: JV
authors.lastname: Tu
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Lee
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000401:mortality; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology*; D006339:Heart Rate / Q000502:physiology*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate
keywords: heart failure; heart rate; hospitalization; mortality; prognosis