In heart failure and reduced ejection fraction, the prognostic role of heart rate (HR) in atrial fibrillation (AF) is unknown and the effectiveness of β-blockers has recently been questioned in AF. Methods and Results-A total of 18 858 patients with heart failure and reduced ejection fraction registered with Swedish Heart Failure Registry were included in this study: patients with sinus rhythm (SR; n=11 466) and patients with AF (n=7392). The outcome measure was all-cause mortality. Compared with HR ≤60 beats per minute, the adjusted hazard ratios for mortality in SR were 1.26 for HR=61 to 70 beats per minute, 1.37 for HR=71 to 80 beats per minute, 1.52 for HR=81 to 90 beats per minute, 1.63 for HR=91 to 100 beats per minute, and 2.69 for HR >100 beats per minute. However, in AF, the hazard ratio increased only for HR >100 beats per minute (1.30; P=0.001). β-blocker use was associated with reduced mortality in SR (hazard ratio, 0.77; P=0.011) and in AF (hazard ratio, 0·71; P<0.001). For β-blocker use in SR, the hazard ratio gradually increased with HR increment, whereas in AF, the hazard ratio significantly increased only for HR >100 beats per minute (1.29; P=0.003) compared with HR ≤60 beats per minute. Conclusions-In patients with heart failure and reduced ejection fraction, a higher HR was associated with increased mortality in SR, but in AF, this is true only for HR >100 beats per minute. β-blocker use was associated with reduced mortality both in SR and in AF.
CITATION STYLE
Li, S. J., Sartipy, U., Lund, L. H., Dahlstrom, U., Adiels, M., Petzold, M., & Fu, M. (2015). Prognostic Significance of Resting Heart Rate and Use of β-Blockers in Atrial Fibrillation and Sinus Rhythm in Patients with Heart Failure and Reduced Ejection Fraction : Findings from the Swedish Heart Failure Registry. Circulation: Heart Failure, 8(5), 871–879. https://doi.org/10.1161/CIRCHEARTFAILURE.115.002285
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