title: Discharge heart rate and mortality after acute myocardial infarction.
abstract: BACKGROUND
  We aimed to describe the determinants of discharge heart rate in acute coronary syndrome patients and assess the impact of discharge heart rate on 5-year mortality in hospital survivors.
  
  
  METHODS
  French Registry of Acute ST-Elevation or non-ST-elevation Myocardial Infarction (FAST-MI) 2005 is a nationwide French registry that included all consecutive patients with acute myocardial infarction over 1 month in 223 institutions in 2005. Discharge heart rate was recorded in 3079 patients discharged alive; all had 5-year follow-up. Logistic regression was used to detect predictors of high heart rate at discharge. Cox's proportional hazards model was used to assess the hazard ratio for mortality at 5 years. Heart rate was categorized into 4 groups by quartiles (<60, 61-67, 68-75, >75 beats per minute). High heart rate was defined as ≥75 beats per minute. Landmark analysis was performed at 1 year.
  
  
  RESULTS
  Independent predictors of heart rate ≥75 beats per minute at discharge were female sex, ST-segment elevation myocardial infarction, diabetes, chronic obstructive pulmonary disease, bleeding/transfusion during hospitalization, left ventricular dysfunction, renal dysfunction, and prescription (type, but not dose category) of beta-blockers at discharge. Discharge heart rate was significantly related to mortality at 1 year (hazard ratio 1.13; 95% confidence interval, 1.03-1.24 per 10 beats per minute, P = .02); this was confirmed by landmark analysis, with a 39% increase (hazard ratio 1.39; 95% confidence interval 1.05-1.84) in the risk of 1-year death for discharge heart rate ≥75 beats per minute vs <75 beats per minute. This relationship was no longer significant between 2 and 5 years.
  
  
  CONCLUSIONS
  After acute myocardial infarction, patients discharged with high heart rate (≥75 beats per minute) are at higher risk of death during the first year, but not later, irrespective of beta-blocker use.
authors.affiliation: University Hospital Jean Minjoz, Besançon, France.
authors.forename: Marie France
authors.initials: MF
authors.lastname: Seronde
authors.affiliation: Hôpital Intercommunal Robert Ballanger, Aulnay-sous-Bois, France.
authors.forename: Raghed
authors.initials: R
authors.lastname: Geha
authors.affiliation: Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Paris, France.
authors.forename: Etienne
authors.initials: E
authors.lastname: Puymirat
authors.affiliation: Centre Hospitalier Intercommunal André Grégoire, Montreuil, France.
authors.forename: Aurès
authors.initials: A
authors.lastname: Chaib
authors.affiliation: AP-HP Hôpital Saint Antoine, Paris, France, INSERM U-698; UPMC, Paris, France.
authors.forename: Tabassome
authors.initials: T
authors.lastname: Simon
authors.affiliation: AP-HP, UF de Pharmacologie Clinique-URCEST, CHU Hôpital Saint Antoine, Paris, France.
authors.forename: Laurence
authors.initials: L
authors.lastname: Berard
authors.affiliation: URC-EST, AP-HP, Hôpital St Antoine, Paris, France.
authors.forename: Elodie
authors.initials: E
authors.lastname: Drouet
authors.affiliation: UMR 1027 INSERM, Toulouse University School of Medicine, Toulouse, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Bataille
authors.affiliation: UMR 1027 INSERM, Toulouse University School of Medicine, Toulouse, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Danchin
authors.affiliation: University Hospital Jean Minjoz, Besançon, France. Electronic address: francois.schiele@Univ-fcomte.fr.
authors.forename: François
authors.initials: F
authors.lastname: Schiele
mesh_terms: D054058:Acute Coronary Syndrome / Q000401:mortality* / Q000503:physiopathology; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D017677:Age Distribution; D000368:Aged; D002423:Cause of Death; D015897:Comorbidity; D005260:Female; D005602:France / Q000453:epidemiology; D006339:Heart Rate; D006801:Humans; D016015:Logistic Models; D008297:Male; D009203:Myocardial Infarction / Q000188:drug therapy / Q000401:mortality* / Q000503:physiopathology; D010351:Patient Discharge / Q000706:statistics & numerical data*; D011379:Prognosis; D016016:Proportional Hazards Models; D012042:Registries; D017678:Sex Distribution; D015996:Survival Rate
chemical_list: D000319:Adrenergic beta-Antagonists
keywords: Heart rate; Mortality; Myocardial infarction; Registry