Heart rate at hospital discharge in patients with heart failure is associated with mortality and rehospitalization

AHA Get With The Guidelines-Heart Failure Program

Research output: Contribution to journalArticle

41 Citations (Scopus)

Abstract

Background--Whether heart rate upon discharge following hospitalization for heart failure is associated with long-term adverse outcomes and whether this association differs between patients with sinus rhythm (SR) and atrial fibrillation (AF) have not been well studied. Methods and Results--We conducted a retrospective cohort study from clinical registry data linked to Medicare claims for 46 217 patients participating in Get With The Guidelines-Heart Failure. Cox proportional-hazards models were used to estimate the association between discharge heart rate and all-cause mortality, all-cause readmission, and the composite outcome of mortality/ readmission through 1 year. For SR and AF patients with heart rate <75, the association between heart rate and mortality (expressed as hazard ratio [HR] per 10 beats-per-minute increment) was significant at 0 to 30 days (SR: HR 1.30, 95% CI 1.22 to 1.39; AF: HR 1.23, 95% CI 1.16 to 1.29) and 31 to 365 days (SR: HR 1.15, 95% CI 1.12 to 1.20; AF: HR 1.05, 95% CI 1.01 to 1.08). Similar associations between heart rate and all-cause readmission and the composite outcome were obtained for SR and AF patients from 0 to 30 days but only in the composite outcome for SR patients over the longer term. The HR from 0 to 30 days exceeded that from 31 to 365 days for both SR and AF patients. At heart rates <75, an association was significant for mortality only for both SR and AF patients.Conclusions: Among older patients hospitalized with heart failure, higher discharge heart rate was associated with increased risks of death and rehospitalization, with higher risk in the first 30 days and for SR compared with AF.

Original languageEnglish (US)
Article numbere001626
JournalJournal of the American Heart Association
Volume4
Issue number4
DOIs
StatePublished - 2015
Externally publishedYes

Fingerprint

Patient Discharge
Atrial Fibrillation
Heart Failure
Heart Rate
Mortality
Medicare
Proportional Hazards Models
Registries
Hospitalization
Cohort Studies
Retrospective Studies
Guidelines

Keywords

  • Heart failure
  • Heart rate
  • Mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Heart rate at hospital discharge in patients with heart failure is associated with mortality and rehospitalization. / AHA Get With The Guidelines-Heart Failure Program.

In: Journal of the American Heart Association, Vol. 4, No. 4, e001626, 2015.

Research output: Contribution to journalArticle

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abstract = "Background--Whether heart rate upon discharge following hospitalization for heart failure is associated with long-term adverse outcomes and whether this association differs between patients with sinus rhythm (SR) and atrial fibrillation (AF) have not been well studied. Methods and Results--We conducted a retrospective cohort study from clinical registry data linked to Medicare claims for 46 217 patients participating in Get With The Guidelines-Heart Failure. Cox proportional-hazards models were used to estimate the association between discharge heart rate and all-cause mortality, all-cause readmission, and the composite outcome of mortality/ readmission through 1 year. For SR and AF patients with heart rate <75, the association between heart rate and mortality (expressed as hazard ratio [HR] per 10 beats-per-minute increment) was significant at 0 to 30 days (SR: HR 1.30, 95{\%} CI 1.22 to 1.39; AF: HR 1.23, 95{\%} CI 1.16 to 1.29) and 31 to 365 days (SR: HR 1.15, 95{\%} CI 1.12 to 1.20; AF: HR 1.05, 95{\%} CI 1.01 to 1.08). Similar associations between heart rate and all-cause readmission and the composite outcome were obtained for SR and AF patients from 0 to 30 days but only in the composite outcome for SR patients over the longer term. The HR from 0 to 30 days exceeded that from 31 to 365 days for both SR and AF patients. At heart rates <75, an association was significant for mortality only for both SR and AF patients.Conclusions: Among older patients hospitalized with heart failure, higher discharge heart rate was associated with increased risks of death and rehospitalization, with higher risk in the first 30 days and for SR compared with AF.",
keywords = "Heart failure, Heart rate, Mortality",
author = "{AHA Get With The Guidelines-Heart Failure Program} and Laskey, {Warren K.} and Ihab Alomari and Margueritte Cox and Phillip Schulte and Xin Zhao and Hernandez, {Adrian F.} and Heidenreich, {Paul A.} and Eapen, {Zubin J.} and Clyde Yancy and Bhatt, {Deepak L.} and Fonarow, {Gregg C.}",
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T1 - Heart rate at hospital discharge in patients with heart failure is associated with mortality and rehospitalization

AU - AHA Get With The Guidelines-Heart Failure Program

AU - Laskey, Warren K.

AU - Alomari, Ihab

AU - Cox, Margueritte

AU - Schulte, Phillip

AU - Zhao, Xin

AU - Hernandez, Adrian F.

AU - Heidenreich, Paul A.

AU - Eapen, Zubin J.

AU - Yancy, Clyde

AU - Bhatt, Deepak L.

AU - Fonarow, Gregg C.

PY - 2015

Y1 - 2015

N2 - Background--Whether heart rate upon discharge following hospitalization for heart failure is associated with long-term adverse outcomes and whether this association differs between patients with sinus rhythm (SR) and atrial fibrillation (AF) have not been well studied. Methods and Results--We conducted a retrospective cohort study from clinical registry data linked to Medicare claims for 46 217 patients participating in Get With The Guidelines-Heart Failure. Cox proportional-hazards models were used to estimate the association between discharge heart rate and all-cause mortality, all-cause readmission, and the composite outcome of mortality/ readmission through 1 year. For SR and AF patients with heart rate <75, the association between heart rate and mortality (expressed as hazard ratio [HR] per 10 beats-per-minute increment) was significant at 0 to 30 days (SR: HR 1.30, 95% CI 1.22 to 1.39; AF: HR 1.23, 95% CI 1.16 to 1.29) and 31 to 365 days (SR: HR 1.15, 95% CI 1.12 to 1.20; AF: HR 1.05, 95% CI 1.01 to 1.08). Similar associations between heart rate and all-cause readmission and the composite outcome were obtained for SR and AF patients from 0 to 30 days but only in the composite outcome for SR patients over the longer term. The HR from 0 to 30 days exceeded that from 31 to 365 days for both SR and AF patients. At heart rates <75, an association was significant for mortality only for both SR and AF patients.Conclusions: Among older patients hospitalized with heart failure, higher discharge heart rate was associated with increased risks of death and rehospitalization, with higher risk in the first 30 days and for SR compared with AF.

AB - Background--Whether heart rate upon discharge following hospitalization for heart failure is associated with long-term adverse outcomes and whether this association differs between patients with sinus rhythm (SR) and atrial fibrillation (AF) have not been well studied. Methods and Results--We conducted a retrospective cohort study from clinical registry data linked to Medicare claims for 46 217 patients participating in Get With The Guidelines-Heart Failure. Cox proportional-hazards models were used to estimate the association between discharge heart rate and all-cause mortality, all-cause readmission, and the composite outcome of mortality/ readmission through 1 year. For SR and AF patients with heart rate <75, the association between heart rate and mortality (expressed as hazard ratio [HR] per 10 beats-per-minute increment) was significant at 0 to 30 days (SR: HR 1.30, 95% CI 1.22 to 1.39; AF: HR 1.23, 95% CI 1.16 to 1.29) and 31 to 365 days (SR: HR 1.15, 95% CI 1.12 to 1.20; AF: HR 1.05, 95% CI 1.01 to 1.08). Similar associations between heart rate and all-cause readmission and the composite outcome were obtained for SR and AF patients from 0 to 30 days but only in the composite outcome for SR patients over the longer term. The HR from 0 to 30 days exceeded that from 31 to 365 days for both SR and AF patients. At heart rates <75, an association was significant for mortality only for both SR and AF patients.Conclusions: Among older patients hospitalized with heart failure, higher discharge heart rate was associated with increased risks of death and rehospitalization, with higher risk in the first 30 days and for SR compared with AF.

KW - Heart failure

KW - Heart rate

KW - Mortality

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