title: Prognostic Significance of Resting Heart Rate and Use of β-Blockers in Atrial Fibrillation and Sinus Rhythm in Patients With Heart Failure and Reduced Ejection Fraction: Findings From the Swedish Heart Failure Registry.
abstract: BACKGROUND
  In heart failure and reduced ejection fraction, the prognostic role of heart rate (HR) in atrial fibrillation (AF) is unknown and the effectiveness of β-blockers has recently been questioned in AF.
  
  
  RESULTS
  A total of 18 858 patients with heart failure and reduced ejection fraction registered with Swedish Heart Failure Registry were included in this study: patients with sinus rhythm (SR; n=11 466) and patients with AF (n=7392). The outcome measure was all-cause mortality. Compared with HR ≤60 beats per minute, the adjusted hazard ratios for mortality in SR were 1.26 for HR=61 to 70 beats per minute, 1.37 for HR=71 to 80 beats per minute, 1.52 for HR=81 to 90 beats per minute, 1.63 for HR=91 to 100 beats per minute, and 2.69 for HR >100 beats per minute. However, in AF, the hazard ratio increased only for HR >100 beats per minute (1.30; P=0.001). β-blocker use was associated with reduced mortality in SR (hazard ratio, 0.77; P=0.011) and in AF (hazard ratio, 0·71; P<0.001). For β-blocker use in SR, the hazard ratio gradually increased with HR increment, whereas in AF, the hazard ratio significantly increased only for HR >100 beats per minute (1.29; P=0.003) compared with HR ≤60 beats per minute.
  
  
  CONCLUSIONS
  In patients with heart failure and reduced ejection fraction, a higher HR was associated with increased mortality in SR, but in AF, this is true only for HR >100 beats per minute. β-blocker use was associated with reduced mortality both in SR and in AF.
authors.affiliation: From the Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, Gothenburg, Sweden (S.-J.L., M.F.); Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China (S.-J.L.); Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, Stockholm, Sweden (U.S.); Department of Molecular Medicine and Surgery (U.S.), Unit of Cardiology, Department of Medicine (L.H.L.), Karolinska Institute, Stockholm, Sweden; Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden (U.D.); and Centre for Applied Biostatistics, University of Gothenburg, Gothenburg, Sweden (M.A., M.P.).
authors.forename: Shi-Jun
authors.initials: SJ
authors.lastname: Li
authors.affiliation: From the Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, Gothenburg, Sweden (S.-J.L., M.F.); Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China (S.-J.L.); Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, Stockholm, Sweden (U.S.); Department of Molecular Medicine and Surgery (U.S.), Unit of Cardiology, Department of Medicine (L.H.L.), Karolinska Institute, Stockholm, Sweden; Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden (U.D.); and Centre for Applied Biostatistics, University of Gothenburg, Gothenburg, Sweden (M.A., M.P.).
authors.forename: Ulrik
authors.initials: U
authors.lastname: Sartipy
authors.affiliation: From the Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, Gothenburg, Sweden (S.-J.L., M.F.); Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China (S.-J.L.); Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, Stockholm, Sweden (U.S.); Department of Molecular Medicine and Surgery (U.S.), Unit of Cardiology, Department of Medicine (L.H.L.), Karolinska Institute, Stockholm, Sweden; Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden (U.D.); and Centre for Applied Biostatistics, University of Gothenburg, Gothenburg, Sweden (M.A., M.P.).
authors.forename: Lars H
authors.initials: LH
authors.lastname: Lund
authors.affiliation: From the Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, Gothenburg, Sweden (S.-J.L., M.F.); Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China (S.-J.L.); Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, Stockholm, Sweden (U.S.); Department of Molecular Medicine and Surgery (U.S.), Unit of Cardiology, Department of Medicine (L.H.L.), Karolinska Institute, Stockholm, Sweden; Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden (U.D.); and Centre for Applied Biostatistics, University of Gothenburg, Gothenburg, Sweden (M.A., M.P.).
authors.forename: Ulf
authors.initials: U
authors.lastname: Dahlström
authors.affiliation: From the Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, Gothenburg, Sweden (S.-J.L., M.F.); Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China (S.-J.L.); Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, Stockholm, Sweden (U.S.); Department of Molecular Medicine and Surgery (U.S.), Unit of Cardiology, Department of Medicine (L.H.L.), Karolinska Institute, Stockholm, Sweden; Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden (U.D.); and Centre for Applied Biostatistics, University of Gothenburg, Gothenburg, Sweden (M.A., M.P.).
authors.forename: Martin
authors.initials: M
authors.lastname: Adiels
authors.affiliation: From the Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, Gothenburg, Sweden (S.-J.L., M.F.); Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China (S.-J.L.); Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, Stockholm, Sweden (U.S.); Department of Molecular Medicine and Surgery (U.S.), Unit of Cardiology, Department of Medicine (L.H.L.), Karolinska Institute, Stockholm, Sweden; Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden (U.D.); and Centre for Applied Biostatistics, University of Gothenburg, Gothenburg, Sweden (M.A., M.P.).
authors.forename: Max
authors.initials: M
authors.lastname: Petzold
authors.affiliation: From the Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, Gothenburg, Sweden (S.-J.L., M.F.); Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China (S.-J.L.); Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, Stockholm, Sweden (U.S.); Department of Molecular Medicine and Surgery (U.S.), Unit of Cardiology, Department of Medicine (L.H.L.), Karolinska Institute, Stockholm, Sweden; Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden (U.D.); and Centre for Applied Biostatistics, University of Gothenburg, Gothenburg, Sweden (M.A., M.P.). Michael.fu@vgregion.se.
authors.forename: Michael
authors.initials: M
authors.lastname: Fu
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology*; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology*; D006339:Heart Rate / Q000187:drug effects / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012042:Registries; D012146:Rest / Q000502:physiology*; D013318:Stroke Volume / Q000502:physiology*; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists
keywords: atrial fibrillation; heart failure; heart rate; mortality; registries