In:
Journal of the American Heart Association, Ovid Technologies (Wolters Kluwer Health), Vol. 5, No. 8 ( 2016-08-08)
Abstract:
The prognostic value of the change in heart rate from the supine to upright position (∆ HR ) in patients with chronic heart failure ( HF ) is unknown. Methods and Results ∆ HR was measured in patients enrolled in the Trial of Intensified Medical Therapy in Elderly Patients with Congestive Heart Failure ( TIME ‐ CHF ) who were in sinus rhythm and had no pacemaker throughout the trial (n=321). The impact of ∆ HR on 18‐month outcome ( HF hospitalization‐free survival) was assessed. In addition, the prognostic effect of changes in ∆ HR between baseline and month 6 on outcomes in the following 12 months was determined. A lower ∆ HR was associated with a higher risk of death or HF hospitalization (hazard ratio 1.79 [95% confidence interval {95% CI } 1.19‐2.75] if ∆ HR ≤3 beats/min [bpm], P =0.004). In the multivariate analysis, lower ∆ HR remained an independent predictor of death or HF hospitalization (hazard ratio 1.75 [95% CI , 1.18‐2.61] if ∆ HR ≤3 bpm, P =0.004) along with ischemic HF etiology, lower estimated glomerular filtration rate, presence and extent of rales, and no baseline β‐blocker use. In patients without event during the first 6 months, the change in ∆ HR from baseline to month 6 predicted death or HF hospitalization during the following 12 months (hazard ratio=2.13 [95% CI 1.12–5.00] if rise in ∆ HR 〈 2 bpm; P =0.027). Conclusions ∆ HR as a simple bedside test is an independent prognostic predictor in patients with chronic HF . ∆ HR is modifiable, and changes in ∆ HR also provide prognostic information, which raises the possibility that ∆ HR may help to guide treatment. Clinical Trial Registration Information URL : www.isrctn.org . Unique identifier: ISRCTN 43596477.
Type of Medium:
Online Resource
ISSN:
2047-9980
DOI:
10.1161/JAHA.116.003524
Language:
English
Publisher:
Ovid Technologies (Wolters Kluwer Health)
Publication Date:
2016
detail.hit.zdb_id:
2653953-6
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