Heart rate elevations over time predict a higher CV risk in HFpEF
Prognostic Importance of Temporal Changes in Resting Heart Rate in Heart Failure and Preserved Ejection Fraction - From the TOPCAT StudyLiterature - Vazir A, Claggett B, Pitt B, et al. - J Am Coll Cardiol HF 2017; published online ahead of print
- The mean LVEF was 58 ± 8%. More than 40% out of 1767 patients had AF at baseline, and a third of the patients were receiving anticoagulation.
- The median values of resting HR measured at any visit were almost identical to the resting baseline HR of 68 beats/min (IQR: 61-76 beats/min)
- Most patients had no change of HR since the preceding visit (median 0 beats/min; IQR: -6 to 6 beats/min).
- 522 patients (11.5% [95% CI: 10.5-12.5]) experienced the primary outcome during a median follow-up time of 3.3 years.
- As a continuous covariate, both baseline HR (adjusted HR: 1.08; 95% CI: 1.04-1.12) and time-updated HR (adjusted HR: 1.11; 95% CI: 1.07-1.15) were associated with the primary outcome, as well as with most other adverse outcomes.
- For each 5 beats/min increase in HR at any time, the primary endpoint and all-cause mortality were 11% and 17% higher, respectively.
- As a continuous covariate, change in HR from the preceding visit was associated with the primary outcome (adjusted HR: 1.09; 95% CI: 1.05-1.14) and all other outcomes, except for fatal and non-fatal MI. Each 5 beats/min increase in HR from the preceding visit was associated with a 9% higher risk for the primary outcome and a 17% higher risk for all-cause mortality, as well as with a 14%, 11%, and 20% higher risk for CV death, hospitalization for HF, and non-CV death, respectively.
- Any rise in HR was associated with elevated risk for the primary endpoint, while a decline in HR did not show a significant association with lower risk.
- In patients experiencing the primary endpoint, a rise in HR of >10 beats/min was seen 5 to 10 days prior to the primary endpoint.
- When the data were categorically analyzed, a rise in HR of >10 beats/min was associated with a 70% higher risk of the primary endpoint, and even greater risk increases were seen for other adverse outcomes. Conversely, a drop in HR >10 beats/min did show significant risk reductions for all-cause mortality and non-CV death.
In patients with HFpEF, including those with AF, a higher baseline resting HR and time-updated HR, and an increase in resting HR over time from the preceding clinic visit were independently associated with an elevated risk for CV events. However, a decline in HR over time was not associated with a lower risk for CV events. These findings support the importance of measuring resting HR in everyday clinical practice, to identify HFpEF patients at higher risk for readmission and death.