Relationship between Heart Rate and Mortality and Morbidity in the Irbesartan Patients with Heart Failure and Preserved Systolic Function Trial (I-Preserve)

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  • Michael Böhm
    Universitätsklinikum des Saarlandes , Homburg/Saar ,
  • Ana-Cristina Perez
    BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow , Glasgow ,
  • Pardeep S. Jhund
    BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow , Glasgow ,
  • Jan C. Reil
    Universitätsklinikum des Saarlandes , Homburg/Saar ,
  • Michel Komajda
    Université Paris 6 and Hospital Pitié–Salpêtrière , Paris ,
  • Michael R. Zile
    Ralph H. Johnson Veterans Affairs Medical Center and Medical University of South Carolina , Charleston ,
  • Robert S McKelvie
    Hamilton Health Sciences, McMaster University , Hamilton, ON ,
  • Inder S Anand
    Veterans Affairs Medical Center and University of Minnesota , Minneapolis, MN ,
  • Barry M. Massie
    University of California, San Francisco, and San Francisco Veterans Affairs Medical Center , San Francisco ,
  • Peter E. Carson
    Georgetown University and Washington DC Veterans Affairs Medical Center , Washington, DC ,
  • John J. V. McMurray
    BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow , Glasgow ,

Bibliographic Information

Published
2014-05-23
Rights Information
  • https://academic.oup.com/pages/standard-publication-reuse-rights
DOI
  • 10.1002/ejhf.85
Publisher
Oxford University Press (OUP)

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<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Background</jats:title> <jats:p>Higher heart rate is associated with poorer outcomes in patients with heart failure and reduced ejection fraction (HF-REF). Less is known about the association between heart rate and outcomes in patients with heart failure and preserved ejection fraction (HF-PEF). Therefore, we examined the relationship between heart rate and outcomes in the irbesartan in patients with heart failure and preserved systolic function trial (I-Preserve) in patients with an ejection fraction &gt;45% aged &gt;60 years.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods and results</jats:title> <jats:p>Heart rate was analysed as both a categorical (tertiles) and continuous variable. Patients in sinus rhythm (n = 3271) and atrial fibrillation (n = 696) were analysed separately. The outcomes examined were the primary endpoint of the trial (all-cause death or cardiovascular hospitalization), the composite of cardiovascular death or heart failure hospitalization (and its components) and all-cause death alone. Higher heart rate was associated with a significantly higher risk of all outcomes studied for patients in sinus rhythm, even after adjustment for other prognostic variables, including N-terminal pro-B-type natriuretic peptide. Each standard deviation (12.4 bpm) increase in heart rate was associated with an increase in risk of 13% for cardiovascular death or heart failure hospitalization (P = 0.002). No relationship between heart rate and outcomes was observed for patients in atrial fibrillation. Beta-blocker treatment did not reduce the heart rate–risk relationship.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>In patients with heart failure and preserved ejection fraction, heart rate is in sinus rhythm an independent predictor of adverse clinical outcomes and might be a therapeutic target in this syndrome.</jats:p> <jats:p>Clinical Trial Registration – URL http://www.clinicaltrials.gov. Unique identifier: NCT0095238</jats:p> </jats:sec>

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