Heart Rate at Hospital Discharge in Patients With Heart Failure Is Associated With Mortality and Rehospitalization
Open accessAbstract
Background: Whether heart rate upon discharge following hospitalization for heart failure is associated with long‐term adverse outcomes and whether this association differs between patients with sinus rhythm ( SR ) and atrial fibrillation ( AF ) have not been well studied. Methods and Results: We conducted a retrospective cohort study from clinical registry data linked to Medicare claims for 46 217 patients participating in Get With The Guidelines ® –Heart Failure. Cox proportional‐hazards models were used to estimate the association between discharge heart rate and all‐cause mortality, all‐cause readmission, and the composite outcome of mortality/readmission through 1 year. For SR and AF patients with heart rate ≥75, the association between heart rate and mortality (expressed as hazard ratio [ HR ] per 10 beats‐per‐minute increment) was significant at 0 to 30 days ( SR : HR 1.30, 95% CI 1.22 to 1.39; AF : HR 1.23, 95% CI 1.16 to 1.29) and 31 to 365 days ( SR : HR 1.15, 95% CI 1.12 to 1.20; AF : HR 1.05, 95% CI 1.01 to 1.08). Similar associations between heart rate and all‐cause readmission and the composite outcome were obtained for SR and AF patients from 0 to 30 days but only in the composite outcome for SR patients over the longer term. The HR from 0 to 30 days exceeded that from 31 to 365 days for both SR and AF patients. At heart rates <75, an association was significant for mortality only for both SR and AF patients. Conclusions: Among older patients hospitalized with heart failure, higher discharge heart rate was associated with increased risks of death and rehospitalization, with higher risk in the first 30 days and for SR compared with AF .
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The effect of elevated heart rate on outcomes becomes apparent within 30 days of discharge from hospital.
“Studies have shown that the effect of elevated heart rate on outcomes becomes apparent within 30 days of discharge from hospital.”
From CCS/CHFS Heart Failure Guidelines Update: Defining a New Pharmacologic Standard of Care for Heart Failure With Reduced Ejection Fraction (2021) · cites this paper as [55]
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McDonald, M., Virani, S., Chan, M., Ducharme, A., Ezekowitz, J. A., Giannetti, N., Heckman, G. A., Howlett, J. G., Koshman, S. L., Lepage, S., et al. (2021) · Canadian Journal of Cardiology · doi:10.1016/j.cjca.2021.01.017 · Cited by 287 · see citing works
Docherty, K. F., Shen, L., Castagno, D., Petrie, M. C., Abraham, W. T., Böhm, M., Desai, A. S., Dickstein, K., Køber, L. V., Packer, M., et al. (2020) · European Journal of Heart Failure · doi:10.1002/ejhf.1682 · Cited by 42 · see citing works
- Authors
- Laskey, W. K., Alomari, I., Cox, M., Schulte, P. J., Zhao, X., Hernandez, A. F., Heidenreich, P. A., Eapen, Z. J., Yancy, C., Bhatt, D. L., Fonarow, G. C., & Program, T. A. G. W. T. G. F.
- Affiliations
- University of New Mexico (US)
- University of California, Irvine (US)
- Duke University (US)
- VA Palo Alto Health Care System (US)
- Northwestern University (US)
- Brigham and Women's Hospital (US)
- University of California, Los Angeles (US)
- Corresponding author
- Laskey, Warren K.
- ORCID
- Venue
- Journal of the American Heart Association
- Published
- 2015-04-22
- Volume
- 4
- Issue
- 4
- ISSN
- 2047-9980 (ISSN-L)
- PMC
- PMC4579947
- OpenAlex
- W2171211014
- Cited by
- 80
- References
- 1
- Citations by year
- 2026: 2 · 2025: 7 · 2024: 6 · 2023: 2 · 2022: 1 · 2021: 10 · 2020: 10 · 2019: 7 · 2018: 10 · 2017: 10 · 2016: 11 · 2015: 4
- FWCI
- 8.49
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by-nc
- Locations
- Journal of the American Heart Association (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
- eScholarship (California Digital Library) (submittedVersion)
- eScholarship (California Digital Library) (submittedVersion, cc-by-nc)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart rate and cardiovascular health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Keywords
- heart failure, atrial fibrillation, sinus rhythm, all-cause mortality, hospital readmission, older adults, prognostic factors
- MeSH terms
- Aged, Aged, 80 and over, Atrial Fibrillation, Female, Heart Failure, Heart Rate, Humans, Male, Patient Discharge, Patient Readmission, Retrospective Studies, Risk Factors
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