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Prognostic significance of resting heart rate in atrial fibrillation patients with heart failure with reduced ejection fraction

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Abstract

The prognostic significance of resting heart rate (HR) in atrial fibrillation (AF) patients with heart failure with reduced ejection fraction (HFrEF) is unclear, and there are no recommendations about the optimal HR in patients with HF in the current guidelines. Thus, we aimed to identify the relationship between resting HR and mortality in AF patients with HFrEF. A prospective multicenter cohort study was conducted between July 2014 and December 2018. We enrolled consecutive 144 AF patients with HFrEF (mean age 75 years, 34% female). The primary endpoint was all-cause death. We compared the outcomes between the high HR group (HR > 81 beats per minute [bpm], interquartile range [IQR] of HR ≥ 67%, n = 50), and the low HR group (HR ≤ 81 bpm, IQR of HR < 67%, n = 94). During a median follow-up of 538 days, the primary endpoint occurred in 41 (28.5%) patients. In Kaplan–Meier analysis, high HR was associated with a progressively increased risk of mortality (log-rank test, p = 0.034). After multivariate Cox regression analysis, high HR predicted all-cause death after adjusting for age, sex, hemoglobin, estimated glomerular filtration rate, LVEF, use of angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, beta-blockers, digoxin, amiodarone, and calcium channel blockers (hazard ratio, 1.979; 95% confidence interval, 1.005–3.898; p = 0.048). Resting HR > 81 bpm at discharge had a significantly higher risk of death compared with HR ≤ 81 bpm in AF patients with HFrEF.

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Acknowledgements

We thank all the following 14 hospitals that participated in this study (Shinshu Ueda Medical Center, Nagano Red Cross Hospital, Matsumoto Medical Center, Nagano Municipal Hospital, Iida Municipal Hospital, Aizawa Hospital, Ina Central Hospital, Okaya City Hospital, Saku Central Hospital, Hokushin General Hospital, Suwa Red Cross Hospital, Matsushiro General Hospital, Shinshu Medical Center, and Asama Nanroku Komoro Medical Center). The authors also acknowledge the secretarial assistance of Minako Aono.

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Authors and Affiliations

  1. Department of Cardiovascular Medicine, Minaminagano Medical Center, Shinonoi General Hospital, Nagano, Japan

    Sho Suzuki, Yusuke Kanzaki, Takuya Maruyama, Naoto Hashizume, Ayako Kozuka & Kumiko Yahikozawa

  2. Department of Cardiovascular Medicine, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, Nagano, 3908621, Japan

    Hirohiko Motoki & Koichiro Kuwahara

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  1. Sho Suzuki
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  2. Hirohiko Motoki
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Correspondence to Hirohiko Motoki.

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Suzuki, S., Motoki, H., Kanzaki, Y. et al. Prognostic significance of resting heart rate in atrial fibrillation patients with heart failure with reduced ejection fraction. Heart Vessels 35, 1109–1115 (2020). https://doi.org/10.1007/s00380-020-01573-5

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