title: Prognostic Value of the Change in Heart Rate From the Supine to the Upright Position in Patients With Chronic Heart Failure.
abstract: The prognostic value of the change in heart rate from the supine to upright position (∆HR) in patients with chronic heart failure (HF) is unknown.
  
  
  
  ∆HR was measured in patients enrolled in the Trial of Intensified Medical Therapy in Elderly Patients with Congestive Heart Failure (TIME-CHF) who were in sinus rhythm and had no pacemaker throughout the trial (n=321). The impact of ∆HR on 18-month outcome (HF hospitalization-free survival) was assessed. In addition, the prognostic effect of changes in ∆HR between baseline and month 6 on outcomes in the following 12 months was determined. A lower ∆HR was associated with a higher risk of death or HF hospitalization (hazard ratio 1.79 [95% confidence interval {95% CI} 1.19-2.75] if ∆HR ≤3 beats/min [bpm], P=0.004). In the multivariate analysis, lower ∆HR remained an independent predictor of death or HF hospitalization (hazard ratio 1.75 [95% CI, 1.18-2.61] if ∆HR ≤3 bpm, P=0.004) along with ischemic HF etiology, lower estimated glomerular filtration rate, presence and extent of rales, and no baseline β-blocker use. In patients without event during the first 6 months, the change in ∆HR from baseline to month 6 predicted death or HF hospitalization during the following 12 months (hazard ratio=2.13 [95% CI 1.12-5.00] if rise in ∆HR <2 bpm; P=0.027).
  
  
  
  ∆HR as a simple bedside test is an independent prognostic predictor in patients with chronic HF. ∆HR is modifiable, and changes in ∆HR also provide prognostic information, which raises the possibility that ∆HR may help to guide treatment.
  
  
  
  URL: www.isrctn.org. Unique identifier: ISRCTN43596477.
authors: Division of Cardiology, Kantonsspital St. Gallen, St. Gallen, Switzerland Division of Cardiology, University Hospital Basel, Basel, Switzerland micha.maeder@kssg.ch.
authors: Micha T
authors: MT
authors: Maeder
authors: Division of Cardiology, Kantonsspital St. Gallen, St. Gallen, Switzerland Division of Cardiology, University Hospital Basel, Basel, Switzerland.
authors: Marzena
authors: M
authors: Zurek
authors: Division of Cardiology, Kantonsspital St. Gallen, St. Gallen, Switzerland.
authors: Hans
authors: H
authors: Rickli
authors: Division of Cardiology, University Hospital Basel, Basel, Switzerland.
authors: Daniel
authors: D
authors: Tobler
authors: Division of Cardiology, Kantonsspital Baselland Bruderholz, Bruderholz, Switzerland.
authors: Stephanie
authors: S
authors: Kiencke
authors: Cardiology Division, Inselspital Bern, Berne, Switzerland.
authors: Thomas
authors: T
authors: Suter
authors: Division of Cardiology, Kantonsspital, Lucerne, Switzerland.
authors: Se-Il
authors: SI
authors: Yoon
authors: Cardiology Practice, Bülach, Switzerland.
authors: Barbara
authors: B
authors: Julius
authors: Division of Cardiology, University Hospital Basel, Basel, Switzerland.
authors: Matthias E
authors: ME
authors: Pfisterer
authors: Division of Cardiology, University Hospital Basel, Basel, Switzerland Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands.
authors: Hans-Peter
authors: HP
authors: Brunner-La Rocca
mesh_terms: D000368:Aged; D002908:Chronic Disease; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D006339:Heart Rate / Q000502:physiology*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D011187:Posture / Q000502:physiology*; D011379:Prognosis; D016683:Supine Position / Q000502:physiology*
keywords: TIME‐CHF; autonomic nervous system; heart failure; heart rate/heart rate variability; prognosis