Prognostic Value of the Change in Heart Rate From the Supine to the Upright Position in Patients With Chronic Heart Failure

Abstract

Background: The prognostic value of the change in heart rate from the supine to upright position (ΔHR) in patients with chronic heart failure (HF) is unknown. Methods and Results: ΔHR was measured in patients enrolled in the Trial of Intensified Medical Therapy in Elderly Patients with Congestive Heart Failure (TIME-CHF) who were in sinus rhythm and had no pacemaker throughout the trial (n=321). The impact of ΔHR on 18-month outcome (HF hospitalization-free survival) was assessed. In addition, the prognostic effect of changes in ΔHR between baseline and month 6 on outcomes in the following 12 months was determined. A lower ΔHR was associated with a higher risk of death or HF hospitalization (hazard ratio 1.79 [95% confidence interval (95% CI) 1.19-2.75] if ΔHR ≤3 beats/min [bpm], P=0.004). In the multivariate analysis, lower ΔHR remained an independent predictor of death or HF hospitalization (hazard ratio 1.75 [95% CI, 1.18-2.61] if ΔHR ≤3 bpm, P=0.004) along with ischemic HF etiology, lower estimated glomerular filtration rate, presence and extent of rales, and no baseline β-blocker use. In patients without event during the first 6 months, the change in ΔHR from baseline to month 6 predicted death or HF hospitalization during the following 12 months (hazard ratio=2.13 [95% CI 1.12-5.00] if rise in ΔHR <2 bpm; P=0.027). Conclusions: ΔHR as a simple bedside test is an independent prognostic predictor in patients with chronic HF. ΔHR is modifiable, and changes in ΔHR also provide prognostic information, which raises the possibility that ΔHR may help to guide treatment.