Author + information
- Received July 16, 2017
- Revision received August 15, 2017
- Accepted August 18, 2017
- Published online October 30, 2017.
- Ali Vazir, MBBS, PhDa,b,
- Brian Claggett, PhDa,
- Bertram Pitt, MDc,
- Inder Anand, MDd,
- Nancy Sweitzer, MD, PhDe,
- James Fang, MDf,
- Jerome Fleg, MDg,
- Jean Rouleau, MDh,
- Sanjiv Shah, MDi,
- Marc A. Pfeffer, MD, PhDa and
- Scott D. Solomon, MDa,∗ ()
- aDivision of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Massachusetts
- bRoyal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust and Institute of Cardiovascular Medicine and Sciences, National Heart and Lung Institute, Imperial College London, London, United Kingdom
- cUniversity of Michigan Medical School, Ann Arbor, Michigan
- dDivision of Cardiology, University of Minnesota, Minneapolis
- eDivision of Cardiovascular Medicine, University of Arizona, Tucson, Arizona
- fDivision of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah
- gNational Heart, Lung, and Blood Institute, Division of Cardiovascular Sciences, Bethesda, Maryland
- hDepartment of Medicine/Cardiology, Montréal Heart Institute, Université de Montréal, Montréal, Québec, Canada
- iDivision of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- ↵∗Address for correspondence:
Dr. Scott D. Solomon, Brigham and Women’s Hospital, Cardiovascular Division, 75 Francis Street, Boston, Massachusetts 02115.
Objectives The aim of this study was to examine the relationship between baseline heart rate (HR), change in HR from a preceding visit, and time-updated HR with subsequent outcomes in patients with heart failure with preserved ejection fraction (HFpEF) in the TOPCAT (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist) trial.
Background Higher resting HR and increase in HR over time in patients with heart failure are associated with adverse outcomes. Whether these relationships between HR and prognosis are also observed in patients with HFpEF requires further assessment.
Methods In 1,767 patients enrolled in the TOPCAT trial from the Americas, the associations between baseline resting HR and change in HR from the preceding visit and clinical outcomes were examined using Cox proportional hazards models, along with the association between HR at each visit and outcome.
Results Both baseline HR (adjusted hazard ratio: 1.08; 95% confidence interval: 1.04 to 1.12) and change in HR from the preceding visit (adjusted hazard ratio: 1.09; 95% confidence interval: 1.05 to 1.14; p < 0.001 per 5 beats/min higher HR), after adjusting for covariates, were associated with a higher risk for the primary endpoint of cardiovascular death, hospitalization for HF, or aborted cardiac arrest. Time-updated resting HR at each visit was also associated with risk (adjusted hazard ratio: 1.11; 95% confidence interval: 1.07 to 1.15; p < 0.001 per 5 beats/min higher HR). Furthermore, a rise in resting HR of approximately 10 beats/min, beginning approximately 10 days prior to the primary endpoint, was observed.
Conclusions Baseline resting HR and change in HR over time predict outcomes in patients with HFpEF, as does time-updated HR during follow-up. These data suggest that frequent outpatient monitoring of HR, possibly with remote technologies, may identify patients with HFpEF who may be at increased risk for rehospitalization or death.
TOPCAT was funded by the National Institutes of Health, National Heart, Lung, and Blood Institute (contract number HHSN268200425207C). The contents of this article are solely the responsibility of the authors and do not necessarily reflect the official views of the National Heart, Lung, and Blood Institute, the National Institutes of Health, or the U.S. government. Dr. Pfeffer has received consulting fees from Aastrom, Abbott Vascular, Amgen, Bristol-Myers Squibb, Cerenis, Concert, Fibrogen, Genzyme, GlaxoSmithKline, Hamilton Health Sciences, Medtronic, Merck, Novo Nordisk, Roche, Salix, Sanderling, Serono, Servier, Teva, and the University of Oxford; and has received grant support from Amgen, Celladon, Novartis, and Sanofi. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received July 16, 2017.
- Revision received August 15, 2017.
- Accepted August 18, 2017.
- 2017 American College of Cardiology Foundation