Impact of elevated heart rate on clinical outcomes in patients with heart failure with reduced and preserved ejection fraction: a report from the CHART-2 Study.
OBJECTIVE
It is still controversial whether elevated baseline heart rate (HR) is associated with higher mortality in patients with heart failure (HF) with preserved ejection fraction (HFpEF). We compared the impacts of baseline HR on mortality in patients with HFpEF and those with HF with reduced ejection fraction (HFrEF).


RESULTS
We enrolled consecutive 2688 patients in Stage C or D HF with sinus rhythm from our Chronic Heart Failure Analysis and Registry in the Tohoku District 2 (CHART-2) Study (n = 10 219). The prognostic impact of HR increase was compared between the two groups, defined as left ventricular ejection fraction of < 50% (HFrEF) and > 50% (HFpEF). Cox regression analysis revealed that elevated baseline HR was associated with increased all-cause mortality in both groups [hazard ratio for the highest tertile (HH) 1.77 in HFrEF, P = 0.008; HH1.82 in HFpEF, P = 0.001]. However, as for mode of death, elevated HR was associated with cardiovascular (CV) death in HFpEF (HH 2.17, P = 0.012), but the association was modest in HFrEF (HH1.49, P = 0.14): in particular, impact on HF death was different between HFpEF (HH 3.79, P = 0.020) and HFrEF (HH 1.07, P = 0.864). In contrast, the prognostic impact of baseline HR on non-CV death was noted only in patients with HFrEF. β-Blocker therapy was associated with reduced HF mortality in HFrEF (hazard ratio 0.49, P = 0.038) but not in HFpEF (hazard ratio 0.64, P = 0.321).


CONCLUSIONS
Elevated HR was associated with increased CV death in HFpEF compared with HFrEF, although its impact on all-cause mortality was comparable between the two groups.
Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, 980-8574, Japan.
Tsuyoshi
T
Takada
Yasuhiko
Y
Sakata
Satoshi
S
Miyata
Jun
J
Takahashi
Kotaro
K
Nochioka
Masanobu
M
Miura
Soichiro
S
Tadaki
Hiroaki
H
Shimokawa
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D005260:Female; D006333:Heart Failure / Q000188:drug therapy / Q000401:mortality* / Q000503:physiopathology*; D006339:Heart Rate / Q000187:drug effects / Q000502:physiology*; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D013318:Stroke Volume / Q000502:physiology
D000319:Adrenergic beta-Antagonists
Heart failure; Heart rate; Prognosis