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Insufficient reduction in heart rate during hospitalization despite beta-blocker treatment in acute decompensated heart failure: insights from the ASCEND-HF trial.

Publication ,  Journal Article
Kitai, T; Grodin, JL; Mentz, RJ; Hernandez, AF; Butler, J; Metra, M; McMurray, JJ; Armstrong, PW; Starling, RC; O'Connor, CM; Swedberg, K; Tang, WHW
Published in: Eur J Heart Fail
February 2017

AIMS: Heart failure (HF) can be associated with a higher resting heart rate (HR), and an elevated HR is associated with adverse long-term events. However, the mechanistic and causal role of HR in HF is unclear. This study aimed to investigate changes in HR during hospitalization, and the association between discharge HR and clinical outcomes as well as an interaction with beta-blocker therapy in patients with acute decompensated HF (ADHF). METHODS AND RESULTS: We studied 2906 patients with an LVEF ≤35%, without AF, who were enrolled in the ASCEND-HF trial. A total of 2492 (85.8%) patients had a HR ≥70 b.p.m. at baseline and 1580 (54.4%) patients were on beta-blocker treatment. Although HR was gradually reduced from baseline to discharge (85.5 ± 15.9 b.p.m. at baseline, 81.7 ± 14.1 b.p.m. at 24 h from treatment initiation, and 79.1 ± 12.2 b.p.m. at discharge), 80.2% of the patients still had a HR ≥70 b.p.m. at discharge. Patients with a HR ≥70 b.p.m. at discharge had significantly lower survival rates than those with a HR <70 b.p.m. (adjusted hazard ratio 1.02, 95% confidence interval 1.01-1.04, P = 0.002). Moreover, HR at discharge had a curvilinear association with mortality, and had no significant interaction effect with beta-blocker therapy at discharge (P = 0.82). CONCLUSIONS: Despite current beta-blocker therapy, many patients with hospitalized ADHF with reduced LVEF have relatively high discharge HR, and discharge HR is associated with higher mortality. Further studies are warranted to determine the optimal strategy for HR control to improve outcomes.

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Published In

Eur J Heart Fail

DOI

EISSN

1879-0844

Publication Date

February 2017

Volume

19

Issue

2

Start / End Page

241 / 249

Location

England

Related Subject Headings

  • Treatment Outcome
  • Survival Rate
  • Stroke Volume
  • Proportional Hazards Models
  • Prognosis
  • Patient Discharge
  • Mortality
  • Middle Aged
  • Male
  • Kaplan-Meier Estimate
 

Citation

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Kitai, T., Grodin, J. L., Mentz, R. J., Hernandez, A. F., Butler, J., Metra, M., … Tang, W. H. W. (2017). Insufficient reduction in heart rate during hospitalization despite beta-blocker treatment in acute decompensated heart failure: insights from the ASCEND-HF trial. Eur J Heart Fail, 19(2), 241–249. https://doi.org/10.1002/ejhf.629
Kitai, Takeshi, Justin L. Grodin, Robert J. Mentz, Adrian F. Hernandez, Javed Butler, Marco Metra, John J. McMurray, et al. “Insufficient reduction in heart rate during hospitalization despite beta-blocker treatment in acute decompensated heart failure: insights from the ASCEND-HF trial.Eur J Heart Fail 19, no. 2 (February 2017): 241–49. https://doi.org/10.1002/ejhf.629.
Kitai T, Grodin JL, Mentz RJ, Hernandez AF, Butler J, Metra M, et al. Insufficient reduction in heart rate during hospitalization despite beta-blocker treatment in acute decompensated heart failure: insights from the ASCEND-HF trial. Eur J Heart Fail. 2017 Feb;19(2):241–9.
Kitai, Takeshi, et al. “Insufficient reduction in heart rate during hospitalization despite beta-blocker treatment in acute decompensated heart failure: insights from the ASCEND-HF trial.Eur J Heart Fail, vol. 19, no. 2, Feb. 2017, pp. 241–49. Pubmed, doi:10.1002/ejhf.629.
Kitai T, Grodin JL, Mentz RJ, Hernandez AF, Butler J, Metra M, McMurray JJ, Armstrong PW, Starling RC, O’Connor CM, Swedberg K, Tang WHW. Insufficient reduction in heart rate during hospitalization despite beta-blocker treatment in acute decompensated heart failure: insights from the ASCEND-HF trial. Eur J Heart Fail. 2017 Feb;19(2):241–249.
Journal cover image

Published In

Eur J Heart Fail

DOI

EISSN

1879-0844

Publication Date

February 2017

Volume

19

Issue

2

Start / End Page

241 / 249

Location

England

Related Subject Headings

  • Treatment Outcome
  • Survival Rate
  • Stroke Volume
  • Proportional Hazards Models
  • Prognosis
  • Patient Discharge
  • Mortality
  • Middle Aged
  • Male
  • Kaplan-Meier Estimate