title: Prognostic impact of heart rate in elderly with systolic heart failure and concomitant atrial fibrillation.
abstract: OBJECTIVE
  The present study aimed to investigate the impact of resting heart rate (HR) on 5-year all-cause mortality in patients ≥80 years with heart failure (HF) with reduced ejection fraction (HFrEF) and concomitant atrial fibrillation (AF) after optimal up-titration of beta-blockers (BBs).
  
  
  METHODS
  Patients (n = 185) aged ≥80 years with HF and left ventricular ejection fraction ≤40% were included between January 2000 and January 2008 from two university hospitals, Sahlgrenska and Östra and retrospectively studied from January 2 to May 30, 2013. Up-titrations of guideline recommended medications were performed at HF outpatient clinics.
  
  
  RESULTS
  Of whole study population, 54% (n= 100) had AF. After optimal up-titration of BBs and angiotensin converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs), mean HR in patients with AF was 73 ± 15 beats/minute (bpm), 36% had resting HR ≤65 bpm. Five-year all-cause mortality among patients with AF was significantly lower in patients with HR ≤65 bpm (63%) compared to HR >65 (80%). Cox proportional-hazard regression analysis adjusted for clinically important baseline variables and doses of ACEIs/ARBs and BBs demonstrated resting HR ≤65 bpm as an independent predictor of improved survival compared to resting HR >65 bpm (HR 0.3, 95%CI 0.1-0.7, P 0.005).
  
  
  CONCLUSIONS
  In octogenarians with HFrEF and concomitant AF, lowering resting HR to levels as low as HR ≤65 bpm was still associated with improved survival from all-cause mortality. Our data indicate that mortality in AF became comparable to SR when patients were on maximally up-titrated beta-blocker doses with HR as low as 75 bpm.
authors.affiliation: a Department of Molecular and Clinical Medicine/Cardiology , Sahlgrenska Academy, University of Gothenburg , Gothenburg , Sweden.
authors.forename: Salim
authors.initials: S
authors.lastname: Barywani
authors.affiliation: b Department of biostatistics , University of Gothenburg , Gothenburg , Sweden.
authors.forename: Max
authors.initials: M
authors.lastname: Petzold
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000369:Aged, 80 and over; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000150:complications* / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology; D016009:Chi-Square Distribution; D005260:Female; D054143:Heart Failure, Systolic / Q000150:complications* / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D016016:Proportional Hazards Models; D012307:Risk Factors; D013318:Stroke Volume; D013548:Sweden; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left
chemical_list: D000319:Adrenergic beta-Antagonists; D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D000889:Anti-Arrhythmia Agents
keywords: HFrEF; Octogenarians; atrial fibrillation; beta-blockers; elderly; resting heart rate; systolic heart failure