Relationship of Elevated Heart Rate in Patients with Heart Failure with Reduced Ejection Fraction to One-Year Outcomes and Costs

摘要

There are limited data describing outcomes associated with an elevated heart rate in patients with heart failure with reduced ejection fraction (HFrEF) in routine clinical practice. We identified patients with HFrEF at Duke University Hospital undergoing echocardiograms and heart rate assessments without paced rhythms or atrial fibrillation. Outcomes (all-cause mortality or hospitalization and medical costs per day alive) were assessed using electronic medical records, hospital cost accounting data, and national death records. Patients were stratified by heart rate (<70, ≥70 bpm) and compared using generalized linear models specified with gamma error distributions and log-links for costs and proportional hazard models for mortality/hospitalization. Of 722 eligible patients, 582 (81%) were treated with beta-blockers. The median heart rate was 81 bpm (25^th, 75^th percentile 69–96) and 527 (73%) had a heart rate ≥70 bpm. After multivariable adjustment, a heart rate ≥70 bpm was associated with increased 1-year all-cause mortality or hospitalization, hazard ratio 1.37 (95% CI 1.07, 1.75) and increased medical costs per day alive, cost ratio 2.03 (95% CI 1.53, 2.69). In conclusion, at a large tertiary care center, despite broad use of beta-blockers, a heart rate ≥70 bpm was observed in 73% of patients with HFrEF and associated with worse 1-year outcomes and increased direct medical costs per day alive.