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Association of heart rate at hospital discharge with mortality and hospitalizations in patients with heart failure

Habal MV, Liu PP, Austin PC, Ross HJ, Newton GE, Wang X, Tu JV, Lee DS. Circ Heart Fail. 2014; 7(1):12-20. Epub 2013 Dec 2.

Background — Heart failure (HF) is associated with a high burden of morbidity and mortality. Hospital discharge is an opportunity for identification of modifiable prognostic factors in the transition to chronic HF.

Methods and Results — The authors examined the association of discharge heart rate with 30-day and one-year mortality and hospitalization outcomes in a cohort of 9097 HF patients discharged from hospital. Discharge heart rate was categorized into predefined groups: 40-60 (n=1333), 61-70 (n=2170), 71-80 (n=2631), 81-90 (n=1700), and >90 beats/min (n=1263). There was a significant increase in all-cause 30-day mortality with adjusted odds ratios (aOR) of 1.59 (95%CI; 1.18-2.14, p=0.003) for discharge heart rates 81-90 beats/min and 1.56 (95%CI; 1.13-2.16, p=0.007) for heart rates >90 beats/min, compared with the reference group (heart rates 61-70 beats/min). Cardiovascular death risk at 30 days was also higher with aOR 1.59 (discharge heart rates 81-90 beats/min, 95%CI; 1.09-2.33, p=0.017) and 1.65 (discharge heart rates >90 beats/min, 95%CI; 1.09-2.48, p=0.017). One-year all-cause mortality (aOR 1.41, 95%CI 1.16-1.72, p<0.001) and cardiovascular death (aOR 1.47, 95%CI; 1.12-1.92, p=0.005) were higher with discharge heart rates >90 beats/min compared to the reference group (heart rates 40-60 beats/min). Readmissions for HF (adjusted hazards ratio 1.26, 95%CI; 1.04-1.54, p=0.021) and cardiovascular disease (adjusted hazards ratio 1.29, 95%CI; 1.08-1.54, p=0.004) within 30 days were also higher with discharge heart rates >90 beats/min.

Conclusions — Higher discharge heart rates were associated with greater risk of all-cause and cardiovascular mortality up to one-year follow-up, and an elevated risk of 30-day readmission for HF and cardiovascular disease.

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Keywords: Cardiovascular diseases