title: Heart rate and adverse outcomes in patients with atrial fibrillation: A combined AFFIRM and AF-CHF substudy.
abstract: BACKGROUND
  An elevated resting heart rate has been associated with adverse cardiovascular outcomes. Its prognostic value has not specifically been examined in patients with atrial fibrillation.
  
  
  OBJECTIVE
  The purpose of this study was to assess the relationship between resting heart rate measured in sinus rhythm and in atrial fibrillation and subsequent hospitalizations and death.
  
  
  METHODS
  An analysis of individual patient-level data from subjects enrolled in the AFFIRM and AF-CHF trials was conducted to determine the impact of resting heart rate on hospitalizations and mortality. Separate analyses were performed in atrial fibrillation and sinus rhythm. A total of 7159 baseline ECGs (4848 in atrial fibrillation, 2311 in sinus rhythm) were analyzed in 5164 patients (34.8% female, age 68.2 ± 8.3 years).
  
  
  RESULTS
  During mean follow-up of 40.8 ± 16.3 months, 1016 patients died (668 cardiovascular deaths), and 3150 required at least 1 hospitalization (2215 cardiovascular). An elevated baseline heart rate in sinus rhythm was associated with increased all-cause mortality [hazard ratio (HR) 1.24 per 10 bpm increase, 95% confidence interval (CI) 1.14-1.36, P < .0001]. In contrast, a baseline heart rate in atrial fibrillation was not associated with mortality. However, compared to heart rates 90-114 bpm in atrial fibrillation, a heart rate >114 bpm was independently associated with all-cause (HR 1.18, 95% CI 1.06-1.31, P = .0018) and cardiovascular (HR 1.25, 95% CI 1.10-1.42, P = .0005) hospitalizations.
  
  
  CONCLUSIONS
  In patients with a history of atrial fibrillation, an elevated baseline heart rate in sinus rhythm is independently associated with mortality. In contrast, the baseline heart rate in atrial fibrillation is not associated with mortality but predicts hospitalizations.
authors: Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.
authors: Jason G
authors: JG
authors: Andrade
authors: Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.
authors: Denis
authors: D
authors: Roy
authors: Libin Cardiovascular Institute, Calgary, Alberta, Canada.
authors: D George
authors: DG
authors: Wyse
authors: Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada; Montreal Heart Institute Coordinating Center, Montreal, Quebec, Canada.
authors: Jean-Claude
authors: JC
authors: Tardif
authors: Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.
authors: Mario
authors: M
authors: Talajic
authors: Montreal Heart Institute Coordinating Center, Montreal, Quebec, Canada.
authors: Hugues
authors: H
authors: Leduc
authors: Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.
authors: Julia-Cadrin
authors: JC
authors: Tourigny
authors: Montreal Heart Institute Coordinating Center, Montreal, Quebec, Canada.
authors: Azadeh
authors: A
authors: Shohoudi
authors: Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.
authors: Marc
authors: M
authors: Dubuc
authors: Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.
authors: Léna
authors: L
authors: Rivard
authors: Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.
authors: Peter G
authors: PG
authors: Guerra
authors: Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.
authors: Bernard
authors: B
authors: Thibault
authors: Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.
authors: Katia
authors: K
authors: Dyrda
authors: Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.
authors: Laurent
authors: L
authors: Macle
authors: Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada; Montreal Heart Institute Coordinating Center, Montreal, Quebec, Canada. Electronic address: paul.khairy@umontreal.ca.
authors: Paul
authors: P
authors: Khairy
mesh_terms: D001281:Atrial Fibrillation / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D019468:Disease Management; D004562:Electrocardiography / Q000379:methods; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D011379:Prognosis; D016016:Proportional Hazards Models; D012146:Rest / Q000502:physiology*; D018570:Risk Assessment
keywords: Atrial fibrillation; Heart rate; Hospitalization; Mortality; Sinus rhythm