title: Relation of Elevated Heart Rate in Patients With Heart Failure With Reduced Ejection Fraction to One-Year Outcomes and Costs.
abstract: There are limited data describing outcomes associated with an elevated heart rate in patients with heart failure with reduced ejection fraction (HFrEF) in routine clinical practice. We identified patients with HFrEF at Duke University Hospital undergoing echocardiograms and heart rate assessments without paced rhythms or atrial fibrillation. Outcomes (all-cause mortality or hospitalization and medical costs per day alive) were assessed using electronic medical records, hospital cost accounting data, and national death records. Patients were stratified by heart rate (<70 and ≥70 beats/min) and compared using generalized linear models specified with gamma error distributions and log links for costs and proportional hazard models for mortality/hospitalization. Of 722 eligible patients, 582 patients (81%) were treated with β blockers. The median heart rate was 81 beats/min (25th and 75th percentiles 69 to 96) and 527 patients (73%) had a heart rate ≥70 beats/min. After multivariate adjustment, a heart rate ≥70 beats/min was associated with increased 1-year all-cause mortality or hospitalization, hazard ratio 1.37 (95% CI 1.07 to 1.75) and increased medical costs per day alive, cost ratio 2.03 (95% CI 1.53 to 2.69). In conclusion, at a large tertiary care center, despite broad use of β blockers, a heart rate ≥70 beats/min was observed in 73% of patients with HFrEF and associated with worse 1-year outcomes and increased direct medical costs per day alive.
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina; Department of Medicine, Duke University School of Medicine, Durham, North Carolina. Electronic address: adam.devore@duke.edu.
authors.forename: Adam D
authors.initials: AD
authors.lastname: DeVore
authors.affiliation: Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.
authors.forename: Phillip J
authors.initials: PJ
authors.lastname: Schulte
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina; Department of Medicine, Duke University School of Medicine, Durham, North Carolina.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Mentz
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: N Chantelle
authors.initials: NC
authors.lastname: Hardy
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina; Department of Medicine, Duke University School of Medicine, Durham, North Carolina.
authors.forename: Jacob P
authors.initials: JP
authors.lastname: Kelly
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina; Department of Medicine, Duke University School of Medicine, Durham, North Carolina.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Velazquez
authors.affiliation: Amgen Incorporated, Thousand Oaks, California.
authors.forename: Juan F
authors.initials: JF
authors.lastname: Maya
authors.affiliation: Amgen Incorporated, Thousand Oaks, California.
authors.forename: Adrian
authors.initials: A
authors.lastname: Kielhorn
authors.affiliation: Amgen Incorporated, Thousand Oaks, California.
authors.forename: Harshali K
authors.initials: HK
authors.lastname: Patel
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina; Department of Medicine, Duke University School of Medicine, Durham, North Carolina.
authors.forename: Shelby D
authors.initials: SD
authors.lastname: Reed
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina; Department of Medicine, Duke University School of Medicine, Durham, North Carolina.
authors.forename: Adrian F
authors.initials: AF
authors.lastname: Hernandez
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000191:economics* / Q000627:therapeutic use*; D000368:Aged; D003362:Cost-Benefit Analysis; D005260:Female; D006333:Heart Failure / Q000188:drug therapy / Q000191:economics* / Q000401:mortality / Q000503:physiopathology*; D006339:Heart Rate; D017721:Hospital Costs; D006785:Hospitals, University; D006801:Humans; D007297:Inpatients; D008297:Male; D016347:Medical Records Systems, Computerized; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D013318:Stroke Volume; D016019:Survival Analysis; D014481:United States
chemical_list: D000319:Adrenergic beta-Antagonists