RT Journal Article
SR Electronic
T1 Heart rate at first postdischarge visit and outcomes in patients with heart failure
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 1086
OP 1092
DO 10.1136/heartjnl-2017-312364
VO 104
IS 13
A1 Tae-Hun Kim
A1 Hyungseop Kim
A1 In-Cheol Kim
A1 Hyuck-Jun Yoon
A1 Hyoung-Seob Park
A1 Yun-Kyeong Cho
A1 Chang-Wook Nam
A1 Seongwook Han
A1 Seung-Ho Hur
A1 Yoon-Nyun Kim
YR 2018
UL http://heart.bmj.com/content/104/13/1086.abstract
AB Objective Heart rate control is important to prevent adverse outcomes in patients with heart failure (HF). However, postdischarge activity may worsen heart rate control, resulting in readmission. This study aimed to explore the implications of the heart rate differences between discharge and the first outpatient visit (D-O diff).Methods We retrospectively identified 458 patients (male: 46%; mean age: 72 years) discharged after HF. The heart rates at admission, discharge and first outpatient visit were analysed. The primary outcome was a composite of cardiovascular (CV) death and readmission of non-fatal myocardial infarction (MI), non-fatal stroke or non-fatal HF over a mean follow-up of 16 months.Results During follow-up, the clinical outcomes were noted in 223 patients (49%): HF, 199; stroke, 9; MI, 6; CV death, 9. The heart rate at the first outpatient visit (r=−0.311, P<0.001) and D-O diff (r=0.416, P<0.001) showed a better correlation with the time-to-clinical event than the heart rate at admission or discharge. The events group displayed a pronounced heart rate increase (13 beats/min) from discharge to the first outpatient visit compared with the event-free group (a decrease of 2 beats/min). A decrease less than −15 in the D-O diff showed a 4.5-fold risk of clinical outcomes during follow-up (P<0.001).Conclusions A decreased D-O diff was related to the adverse outcomes of HF. The failure of heart rate control within more than 15 beats/min at the first outpatient visit was an independent factor for CV events.