Relation of Elevated Heart Rate in Patients With Heart Failure With Reduced Ejection Fraction to One-Year Outcomes and Costs.

Journal Article (Journal Article)

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.

Full Text

Duke Authors

Cited Authors

  • DeVore, AD; Schulte, PJ; Mentz, RJ; Hardy, NC; Kelly, JP; Velazquez, EJ; Maya, JF; Kielhorn, A; Patel, HK; Reed, SD; Hernandez, AF

Published Date

  • March 15, 2016

Published In

Volume / Issue

  • 117 / 6

Start / End Page

  • 946 - 951

PubMed ID

  • 26805662

Pubmed Central ID

  • PMC5429586

Electronic International Standard Serial Number (EISSN)

  • 1879-1913

Digital Object Identifier (DOI)

  • 10.1016/j.amjcard.2015.12.031


  • eng

Conference Location

  • United States