Poor heart rate control worsens outcomes in HF patients with atrial fibrillation

Strict control of heart rate by discharge may improve outcomes in heart failure (HF) patients with atrial fibrillation (AF), a new study has found.

Accessing data from the Get With The Guidelines-HF Programme, linked with Medicare data, researchers identified 13,981 patients with HF and AF (median age, 82 years; 47.8 percent male). The primary study outcome was all-cause death at 90 days, while 1-year all-cause death and all-cause readmissions at 90 and 365 days were set as secondary endpoints.

Most of the participants (n=9,100) achieved strict heart rate control at discharge, defined as a resting heart rate (RHR) of 80 beats per minute. In comparison, 4,617 were identified to have lenient control (RHR, <100 beats per minute) and 264 had poor control (RHR, >110 beats per minute). Those with higher heart rates at discharge tended to be women and were less likely to have diabetes mellitus.

All-cause death at 90 days occurred in 15.0 percent of participants who achieved strict rate control, as opposed to 19.1 percent and 22.7 percent of those with lenient and poor control. A similar trend was reported for 365-day all-cause mortality and for readmissions at both time points.

Cox proportional hazards modelling showed that lenient rate control significantly increased the risk of 90-day all-cause death relative to strict control (hazard ratio [HR], 1.21, 95 percent confidence interval [CI], 1.11–1.33; p<0.001). No such effect was found for poor control (p=0.181).

On the other hand, both lenient (HR, 1.09, 95 percent CI, 1.03–1.15; p=0.02) and poor (HR, 1.51, 95 percent CI, 1.24–1.83; p<0.001) rate control at discharge were significant risk factors for all-cause readmission at 90 days. Similar patterns of effect were found at 1 year.