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Prognostic Significance of Resting Heart Rate and Use of Beta-Blockers in Atrial Fibrillation and Sinus Rhythm in Patients With Heart Failure and Reduced Ejection Fraction: Findings From the Swedish Heart Failure Registry.
Circ Heart Fail. 2015 Aug 4;
Authors: Li SJ, Sartipy U, Lund LH, Dahlström U, Adiels M, Petzold M, Fu M
Abstract
BACKGROUND: -In heart failure and reduced ejection fraction (HFrEF), the prognostic role of heart rate (HR) in atrial fibrillation (AF) is unknown and the effectiveness of beta blockers has recently been questioned in AF.
METHODS AND RESULTS: -By access to Swedish Heart Failure registry patients with HFrEF (n=18 858) were divided into sinus rhythm (SR) (n=11 466) or AF (n=7392). The endpoint was all-cause mortality. Compared to HR ≤ 60 bpm, the adjusted hazard ratios for mortality in SR were 1•26 for HR 61-70 bpm, 1•37 for HR 71-80 bpm, 1•52 for HR 81-90 bpm, 1•63 for HR 91-100 bpm and 2•69 for HR >100 bpm. However, in AF, the hazard ratio was increased only in HR > 100 bpm (1•30, p = 0•001) compared to HR ≤ 60 bpm. Beta-blocker use was associated with reduced mortality in SR (hazard ratio 0•77, p = 0•011), and in AF (hazard ratio 0•71, p < 0•001). In beta-blocker use in SR, hazard ratio gradually increased with HR increment whereas in AF hazard ratio was significantly increased only in HR > 100 bpm (1•29, p = 0•003) compared to HR ≤ 60 bpm.
CONCLUSIONS: -In patients with HFrEF, a higher HR was associated with increased mortality in SR, and in AF only if > 100 bpm. Beta-blocker use was associated with reduced mortality both in SR and AF.
PMID: 26243796 [PubMed - as supplied by publisher]