title: Elevated heart rate at 24-36h after admission and in-hospital mortality in acute in non-arrhythmic heart failure.
abstract: BACKGROUND
  Elevated resting heart rate is associated with worse outcomes in chronic heart failure (HF) but little is known about its prognostic impact in acute setting. The main aim of the present study was to examine the relationship between resting heart rate obtained 24-36h after admission for acute non-arrhythmic HF and in-hospital mortality.
  
  
  RESULTS
  We examined the association of heart rate with in-hospital mortality in a cohort of 712 patients admitted for acute HF. None of the patients had significant arrhythmias, required invasive ventilation, or presented with acute coronary syndrome or primary valvular disease. Forty patients (5.6%) died during the hospital stay. Those patients were significantly older (78±9 vs. 72±12years; p=0.0021), had higher heart rate (92±22 vs. 78±18bpm; p<0.0001), NT pro-BNP (p=0.0005), creatinine (p=0.023), were often diabetics (p=0.026) and had lower systolic and diastolic blood pressures (p<0.05). There was a significant graded relationship between the increase in mortality rate and tertile of heart rate (p<0.01). With multivariable analysis, age (p=0.037), heart rate (p<0.0001), diastolic blood pressure (p<0.001), prior ischemic heart disease (p=0.02) and creatinine (p=0.019) emerged as independent predictors of in-hospital mortality. After adjusting for predictors of poor prognosis, patients in the highest heart rate tertile had worst outcomes when compared with those in the lowest heart rate group (p=0.007).
  
  
  CONCLUSIONS
  Higher heart rate 24-36h after admission for acute non-arrhythmic HF is associated with increased risk of in-hospital mortality. Early targeting of elevated heart rate might represent a complementary therapeutic challenge.
authors.affiliation: University Hospital of Liège, GIGA Cardiovascular Sciences, Acute Care Unit, Heart Failure Clinic, CHU Sart Tilman, Liège, Belgium. Electronic address: plancellotti@chu.ulg.ac.be.
authors.forename: Patrizio
authors.initials: P
authors.lastname: Lancellotti
authors.affiliation: University Hospital of Liège, GIGA Cardiovascular Sciences, Acute Care Unit, Heart Failure Clinic, CHU Sart Tilman, Liège, Belgium.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Ancion
authors.affiliation: University Hospital of Liège, GIGA Cardiovascular Sciences, Acute Care Unit, Heart Failure Clinic, CHU Sart Tilman, Liège, Belgium.
authors.forename: Julien
authors.initials: J
authors.lastname: Magne
authors.affiliation: University Hospital of Liège, GIGA Cardiovascular Sciences, Acute Care Unit, Heart Failure Clinic, CHU Sart Tilman, Liège, Belgium.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Ferro
authors.affiliation: University Hospital of Liège, GIGA Cardiovascular Sciences, Acute Care Unit, Heart Failure Clinic, CHU Sart Tilman, Liège, Belgium.
authors.forename: Luc A
authors.initials: LA
authors.lastname: Piérard
mesh_terms: D000368:Aged; D001530:Belgium / Q000453:epidemiology; D015716:Electrocardiography, Ambulatory / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000401:mortality / Q000503:physiopathology*; D006339:Heart Rate / Q000502:physiology*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007297:Inpatients; D008297:Male; D010343:Patient Admission; D011379:Prognosis; D012146:Rest / Q000502:physiology; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors
keywords: Heart failure; Heart rate; Outcome; Risk stratification; Treatment