Association Between Discharge Heart Rate and Composite Outcomes in Patients With Heart Failure and Atrial Fibrillation

Background: Recent reports show that heart rate is a prognostic factor in patients with heart failure (HF). However, there are few reports on the association between discharge heart rate (HR) and outcome in patients with HF and atrial fibrillation (Af). Method: We enrolled 202 patients with heart failure admitted to our hospital from 2005 to 2008. The patients were divided into sinus rhythm (SR) (n = 111) and Af groups (n = 91) with or without beta-blocker treatment. Furthermore, these groups were devided into tertiles according to HR (<60, 61–70, >71). The primary endpoint was a composite of all cause mortality and heart failure rehospitalization. Cox proportional hazard models were used to assess the relationship between discharge HR and primary endpoint. Result: The median follow-up was 1.9 years (IQR: 0.5 to 5.5 years) in patients with Af and 2.5 years (IQR: 0.7 to 6.3 years) in patients with SR. After adjustment, lowest tertiles was associated with increased risk of the events in Af patients with beta-blocker treatment (hazard ratio: 2.66, 95% confidence interval (CI): 1.03–6.9), compared to middle tertile in Af patient with beta-blocker. Whereas, we did not observe any association between beta-blocker use and risk of the events in SR patients. Conclusion: In patients with HF and Af receiving beta-blocker treatment, our data suggets that lower heart rate may associate with increased risk of cardiovascular event.