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

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.