title: Relationship between heart rate and mortality and morbidity in the irbesartan patients with heart failure and preserved systolic function trial (I-Preserve).
abstract: BACKGROUND
  Higher heart rate is associated with poorer outcomes in patients with heart failure and reduced ejection fraction (HF-REF). Less is known about the association between heart rate and outcomes in patients with heart failure and preserved ejection fraction (HF-PEF). Therefore, we examined the relationship between heart rate and outcomes in the irbesartan in patients with heart failure and preserved systolic function trial (I-Preserve) in patients with an ejection fraction >45% aged >60 years.
  
  
  RESULTS
  Heart rate was analysed as both a categorical (tertiles) and continuous variable. Patients in sinus rhythm (n = 3271) and atrial fibrillation (n = 696) were analysed separately. The outcomes examined were the primary endpoint of the trial (all-cause death or cardiovascular hospitalization), the composite of cardiovascular death or heart failure hospitalization (and its components) and all-cause death alone. Higher heart rate was associated with a significantly higher risk of all outcomes studied for patients in sinus rhythm, even after adjustment for other prognostic variables, including N-terminal pro-B-type natriuretic peptide. Each standard deviation (12.4 bpm) increase in heart rate was associated with an increase in risk of 13% for cardiovascular death or heart failure hospitalization (P = 0.002). No relationship between heart rate and outcomes was observed for patients in atrial fibrillation. Beta-blocker treatment did not reduce the heart rate-risk relationship.
  
  
  CONCLUSIONS
  In patients with heart failure and preserved ejection fraction, heart rate is in sinus rhythm an independent predictor of adverse clinical outcomes and might be a therapeutic target in this syndrome. Clinical Trial Registration - URL http://www.clinicaltrials.gov. Unique identifier: NCT 0095238.
authors.affiliation: Universitätsklinikum des Saarlandes, Homburg/Saar, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Böhm
authors.forename: Ana-Cristina
authors.initials: AC
authors.lastname: Perez
authors.forename: Pardeep S
authors.initials: PS
authors.lastname: Jhund
authors.forename: Jan C
authors.initials: JC
authors.lastname: Reil
authors.forename: Michel
authors.initials: M
authors.lastname: Komajda
authors.forename: Michael R
authors.initials: MR
authors.lastname: Zile
authors.forename: Robert S
authors.initials: RS
authors.lastname: McKelvie
authors.forename: Inder S
authors.initials: IS
authors.lastname: Anand
authors.forename: Barry M
authors.initials: BM
authors.lastname: Massie
authors.forename: Peter E
authors.initials: PE
authors.lastname: Carson
authors.forename: John J V
authors.initials: JJ
authors.lastname: McMurray
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000401:mortality / Q000503:physiopathology*; D001713:Biphenyl Compounds / Q000627:therapeutic use; D005260:Female; D006333:Heart Failure / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology*; D006339:Heart Rate / Q000502:physiology*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D000077405:Irbesartan; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D013318:Stroke Volume; D013777:Tetrazoles / Q000627:therapeutic use; D018487:Ventricular Dysfunction, Left / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology*
chemical_list: D000319:Adrenergic beta-Antagonists; D047228:Angiotensin II Type 1 Receptor Blockers; D001713:Biphenyl Compounds; D013777:Tetrazoles; D000077405:Irbesartan
keywords: Heart failure; Heart rate; Irbesartan; Morbidity; Mortality