Clinical InvestigationHeart FailureAdmission heart rate and in-hospital outcomes in patients hospitalized for heart failure in sinus rhythm and in atrial fibrillation
Section snippets
Data source
Data were collected through the GWTG-HF program, a national data collection and quality improvement initiative. Details of the GWTG-HF program have been described previously.10 Trained personnel at participating sites abstracted data on consecutive eligible patients using standardized definitions and submitted clinical information using a point-of-service, internet-based Patient Management Tool (Outcome Sciences, Cambridge, MA). All participating institutions are required to comply with local
Sample characteristics
The study cohort included 145,221 admissions reported to GWTG-HF between January 2005 and September 2011 from 295 sites. Among patients with information available on presenting heart rhythm, 77,850 (68.6%) admissions were in SR, 35,636 (31.4%) were in AF. Baseline characteristics of the patients as stratified by quartiles of heart rate for the overall cohort are shown in Table I (with hospital characteristics shown in the online Appendix Supplementary Table I). The median admission heart rate
Discussion
In this study of over 145,000 admissions for HF, presenting heart rate was independently associated with higher rates of in-hospital mortality. The lowest rates of in-hospital mortality occurred between heart rates of 70-75 beat/min, with increased mortality both below and above this range. To the best of our knowledge, this is the first study to demonstrate a J-shaped relationship between mortality and heart rate in acute HF independent of known patient and hospital factors. There also appears
Conclusions
This study provides important insights into the relationship of admission heart rate and in-hospital outcomes among patients hospitalized for acute HF. Higher admission heart rate is independently associated with worse outcomes, including increased mortality, longer length of stay, and lower likelihood of being discharged home. However, the slope of this relationship is different at higher heart rates between patients in SR and AF. In addition, patients with HF and preserved EF had a higher
Funding/Support
The GWTG-HF program is provided by the American Heart Association. GWTG-HF has been funded in the past through support from Medtronic, GlaxoSmithKline, Ortho-McNeil, and the American Heart Association Pharmaceutical Roundtable.
Disclosures
ALB (none), MVG (DCRI employee), AFH (Johnson & Johnson research; Amylin research; Corthera consultant), EDP (PI of the analytic center for the GWTG), CWY (none), DLB (Medscape Cardiology; Boston VA Research Institute, SCPC; Honoraria: ACC, DCRI, Slack Publications, WebMD; Research Grants: Amarin, AstraZeneca, Bristol-Myers Squibb, Eisai, Ethicon, Medtronic, Sanofi Aventis, The Medicines Company), GCF (NHLBI research, Consultant: Novartis, Gambro, Medtronic).
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Jalal K. Ghali, MD served as guest editor for this article.