Abstract

Background

In patients with heart failure with reduced ejection fraction (HFrEF), lower discharge heart rate (HR) is known to be associated with better outcomes. However, the effect of HR control on patient outcomes, and the demographic and clinical determinants of this association, are not well documented.

Objectives

The purpose of this work was to evaluate the association between the HR control and the risk of post-discharge rehospitalization in patients hospitalized with HFrEF.

Methods

Data were collected using a retrospective medical record review in the USA. Reduction in HR between admission and discharge (“HR control”) defined the primary exposure, categorized as no reduction, > 0 to < 20% reduction, and ≥ 20% reduction. Time to first rehospitalization in the post-discharge follow-up defined the study outcome and was analyzed using multivariable Cox regression modeling.

Results

A total of 1002 patients were analyzed (median age, 63 years; median follow-up duration, 24.2 months). At admission, 59.1% received beta-blockers, 57.4% received diuretics, and 47.5% received angiotensin-converting enzyme (ACE) inhibitors. Most patients (90.5%) achieved some HR control (38.4% achieved > 0 to < 20% reduction, and 52% achieved ≥ 20% reduction). Approximately 39% were rehospitalized during the follow-up (14% within 30 days). In multivariable analysis, patients with > 0 to < 20% reduction in HR had a 39% lower risk of rehospitalization [hazard ratio 0.61; 95% confidence interval (CI) 0.43–0.85]; patients with ≥ 20% reduction in HR had a 38% lower rehospitalization risk (hazard ratio 0.62; 95% CI 0.45–0.87) than those with no HR reduction.

Conclusions

Reduction in HR between admission and discharge was associated with reduced risk for rehospitalization. Findings indicate HR control as an important goal in the management of patients hospitalized for HFrEF.

Details

Title
Exploring the Association Between Heart Rate Control and Rehospitalization: A Real-World Analysis of Patients Hospitalized with Heart Failure with Reduced Ejection Fraction
Author
Mody, Freny Vaghaiwalla 1 ; Goyal, Ravi K. 2   VIAFID ORCID Logo  ; Ajmera, Mayank 2 ; Davis, Keith L. 2 ; Amin, Alpesh N. 3 

1  Reagan University of California Medical Center, Los Angeles (UCLA) at the David Geffen School of Medicine at UCLA, Division of Cardiology 111E, Department of Medicine, Veterans Affairs Greater Los Angeles HCS, and the Department of Medicine at Ronald, Los Angeles, USA (GRID:grid.19006.3e) (ISNI:0000 0000 9632 6718) 
2  RTI Health Solutions, Research Triangle Park, USA (GRID:grid.416262.5) (ISNI:0000 0004 0629 621X) 
3  University of California, Irvine, USA (GRID:grid.266093.8) (ISNI:0000 0001 0668 7243) 
Pages
501-511
Publication year
2024
Publication date
Sep 2024
Publisher
Springer Nature B.V.
ISSN
21991154
e-ISSN
21989788
Source type
Scholarly Journal
Language of publication
English
DOI
https://doi.org/10.1007/s40801-024-00436-z
ProQuest document ID
3099209884
Copyright
© This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply 2024. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.