Resting Heart Rate as an Important Predictor of Mortality and Morbidity in Ambulatory Patients With Heart Failure: A Systematic Review and Meta-Analysis |
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| Authors: | Kimberley Lau Abdullah Malik Farid Foroutan Tayler A. Buchan Julian F. Daza Nigar Sekercioglu Ani Orchanian-Cheff Ana C. Alba |
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| Affiliation: | 1. Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada;2. McMaster University, Hamilton, Ontario, Canada;3. Ted Rogers Centre for Heart Research, University Health Network, Toronto, Ontario, Canada;4. University of Toronto, Toronto, Ontario, Canada;5. Library and Information Services, University Health Network, Toronto, Ontario, Canada;1. Duke University Medical Center and Duke Clinical Research Institute, Durham, NC, USA;2. Zena and Michael A. Wiener Cardiovascular Institute and Department of Population Health Science and Policy, Mount Sinai, New York, NY, USA;1. McGaw Medical Center of Northwestern University Feinberg School of Medicine, Department of Medicine, Chicago, Illinois;2. Center for Translational Metabolism and Health, Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois;3. Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois;4. Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota;5. Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts;6. Division of Nephrology, Department of Medicine, Duke University, Durham, North Carolina;7. Division of Nephrology and Hypertension, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois;8. Division of Nephrology, Department of Medicine, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois;1. New England Heart and Vascular Institute, Catholic Medical Center, Manchester, New Hampshire;2. Boston Scientific, Minneapolis, Minnesota;1. Department of Medicine, Weill Cornell Medicine, New York, New York;2. Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas;3. Division of Cardiovascular Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire;4. Division of Cardiology, Kaiser Permanente San Jose Medical Center, San Jose, California;5. Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado;6. Department of Medicine, Columbia University Irving Medical Center, New York, New York;7. Cardiovascular Division, Washington University School of Medicine in St. Louis, St. Louis, Missouri;8. Department of Medicine, University of California-San Francisco, San Francisco, California |
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| Abstract: | BackgroundResting heart rate is a risk factor of adverse heart failure outcomes; however, studies have shown controversial results. This meta-analysis evaluates the association of resting heart rate with mortality and hospitalization and identifies factors influencing its effect.Methods and ResultsWe systematically searched electronic databases in February 2019 for studies published in 2005 or before that evaluated the resting heart rate as a primary predictor or covariate of multivariable models of mortality and/or hospitalization in adult ambulatory patients with heart failure. Random effects inverse variance meta-analyses were performed to calculate pooled hazard ratios. The Grading of Recommendations, Assessment, Development and Evaluation approach was used to assess evidence quality. Sixty-two studies on 163,445 patients proved eligible. Median population heart rate was 74 bpm (interquartile range 72–76 bpm). A 10-bpm increase was significantly associated with increased risk of all-cause mortality (hazard ratio 1.10, 95% confidence interval 1.08–1.13, high quality). Overall, subgroup analyses related to patient characteristics showed no changes to the effect estimate; however, there was a strongly positive interaction with age showing increasing risk of all-cause mortality per 10 bpm increase in heart rate.ConclusionsHigh-quality evidence demonstrates increasing resting heart rate is a significant predictor of all-cause mortality in ambulatory patients with heart failure on optimal medical therapy, with consistent effect across most patient factors and an increased risk trending with older age. |
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