title: Is heart rate a risk marker in patients with chronic heart failure and concomitant atrial fibrillation? Results from the MAGGIC meta-analysis.
abstract: OBJECTIVE
  To investigate the relationship between heart rate and survival in patients with heart failure (HF) and coexisting atrial fibrillation (AF).
  
  
  RESULTS
  Patients with AF included in the Meta-analysis Global Group in Chronic Heart Failure (MAGGIC) meta-analysis were the main focus of this analysis (3259 patients from 17 studies). The outcome was all-cause mortality at 3 years. Heart rate was analysed as a categorical (tertiles; T1 ≤77 b.p.m., T2 78-98 b.p.m., T3 ≥98 b.p.m.) and continuous variable. Cox proportional hazard models were used to compare the risk of all-cause death between tertiles of baseline heart rate. Patients in the highest tertile were more often female, less likely to have an ischaemic aetiology or diabetes, had a lower ejection fraction but higher blood pressure and New York Heart Association (NYHA) class. Higher heart rate was associated with higher mortality in patients with sinus rhythm (SR) but not in those in AF. In patients with heart failure and reduced ejection fraction (HF-REF) and AF, death rates per 100 patient years were lowest in the highest heart rate tertile (T1 18.9 vs. T3 15.9) but this difference was not statistically significant (P = 0.10). In patients with heart failure and preserved ejection fraction (HF-PEF), death rates per 100 patient years were highest in the highest heart rate tertile (T1 14.6 vs. T3 16.0, P = 0.014). However, after adjustment for other important prognostic variables, higher heart rate was no longer associated with higher mortality in HF-PEF (or HF-REF).
  
  
  CONCLUSIONS
  In this meta-analysis of patients with HF, heart rate does not have the same prognostic significance in patients in AF as it does in those in SR, irrespective of ejection fraction or treatment with beta-blocker.
authors.affiliation: BHF Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, Glasgow, G12 8TA, UK.
authors.forename: Joanne
authors.initials: J
authors.lastname: Simpson
authors.affiliation: Division of Cardiology, Department of Medical Sciences, University of Turin, Turin, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Castagno
authors.affiliation: Department of Medicine and National Institute of Health Innovation, University of Auckland, Auckland, New Zealand.
authors.forename: Rob N
authors.initials: RN
authors.lastname: Doughty
authors.affiliation: Department of Medicine and National Institute of Health Innovation, University of Auckland, Auckland, New Zealand.
authors.forename: Katrina K
authors.initials: KK
authors.lastname: Poppe
authors.affiliation: Department of Medicine and National Institute of Health Innovation, University of Auckland, Auckland, New Zealand.
authors.forename: Nikki
authors.initials: N
authors.lastname: Earle
authors.affiliation: University of Leicester, Department of Cardiovascular Sciences and NIHR Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, UK.
authors.forename: Iain
authors.initials: I
authors.lastname: Squire
authors.affiliation: University of Otago, Christchurch, Department of Medicine, Christchurch, New Zealand.
authors.forename: Mark
authors.initials: M
authors.lastname: Richards
authors.affiliation: Sahlgrenska University Hospital, Department of Cardiology, Gothenburg, Sweden.
authors.forename: Bert
authors.initials: B
authors.lastname: Andersson
authors.affiliation: Division of Cardiology and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada.
authors.forename: Justin A
authors.initials: JA
authors.lastname: Ezekowitz
authors.affiliation: Université Paris 6, Pitié Salpetrière Hospital, Paris, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Komajda
authors.affiliation: Scottish National Advanced Heart Failure Service, Golden Jubilee National Hospital, Agamemnon Street, Clydebank, UK.
authors.forename: Mark C
authors.initials: MC
authors.lastname: Petrie
authors.affiliation: The Division of General Internal Medicine, University of Alberta, Edmonton, Canada.
authors.forename: Finlay A
authors.initials: FA
authors.lastname: McAlister
authors.affiliation: Department of Medicine and National Institute of Health Innovation, University of Auckland, Auckland, New Zealand.
authors.forename: Greg D
authors.initials: GD
authors.lastname: Gamble
authors.affiliation: Faculty of Social and Health Sciences, Unitec, Auckland, New Zealand.
authors.forename: Gillian A
authors.initials: GA
authors.lastname: Whalley
authors.affiliation: BHF Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, Glasgow, G12 8TA, UK.
authors.forename: John J V
authors.initials: JJ
authors.lastname: McMurray
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology; D002423:Cause of Death; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D006973:Hypertension / Q000503:physiopathology; D008297:Male; D011379:Prognosis; D016016:Proportional Hazards Models; D012307:Risk Factors; D013223:Statistics as Topic; D013318:Stroke Volume / Q000502:physiology
chemical_list: D000319:Adrenergic beta-Antagonists
keywords: Atrial fibrillation; Heart failure; Heart rate; Preserved ejection fraction; Prognosis