Significance of Resting Heart Rate in Chronic Heart Failure: Data from Cardiac Insufficiency of Various Origin in Jeonbuk (CION-J) Registry

Kyeong Ho Yun; Sun Hwa Lee; Sung-Hee John; Jum Suk Ko; Sang Jae Rhee; Nam Jin Yoo; Nam-Ho Kim; Jay-Young Rhew; Seok Kyu Oh; Won Ho Kim; Jin-Won Jeong

doi:10.5646/jksh.2012.18.1.38

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Yun, Lee, John, Ko, Rhee, Yoo, Kim, Rhew, Oh, Kim, and Jeong: Significance of Resting Heart Rate in Chronic Heart Failure: Data from Cardiac Insufficiency of Various Origin in Jeonbuk (CION-J) Registry

Original Article

Journal of the Korean Society of Hypertension

Journal of the Korean Society of Hypertension 2012; 18(1): 38-45.

Published online: 31 March 2012

DOI: https://doi.org/10.5646/jksh.2012.18.1.38

Significance of Resting Heart Rate in Chronic Heart Failure: Data from Cardiac Insufficiency of Various Origin in Jeonbuk (CION-J) Registry

Kyeong Ho Yun, MD¹, Sun Hwa Lee, MD², Sung-Hee John, MD³, Jum Suk Ko, MD¹, Sang Jae Rhee, MD¹, Nam Jin Yoo, MD¹, Nam-Ho Kim, MD¹, Jay-Young Rhew, MD³, Seok Kyu Oh, MD¹, Won Ho Kim, MD², Jin-Won Jeong, MD¹

¹Division of Cardiology, Department of Internal Medicine, Wonkwang University School of Medicine, Iksan, Korea.

²Division of Cardiology, Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Korea.

³Division of Cardiology, Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Korea.

Correspondence to: jjwcar@wonkwang.ac.kr

Received 30 January 2012 Revised 29 March 2012 Accepted 29 March 2012

Abstract

Background

Chronic heart failure (HF) is a leading cause of morbidity and mortality in industrialized countries. Raised resting heart rate (HR) is a marker of cardiovascular risk in general population, as well as in patients with hypertension and coronary artery disease. We studied the association between HR and cardiovascular events in patients with Cardiac Insufficiency of Various Origin in Jeonbuk (CION-J) registry.

Methods

CION-J registry was a multicenter, prospective database for chronic HF. From January 2010 to December 2010, 356 HF patients who clinically stabilized at least 2 weeks were analyzed. According to resting HR, the patients divided into the tertile (lower tertile < 70/min, n = 129; middle tertile 70-80/min, n = 114; upper tertile > 80/min, n = 113). Clinical outcomes during 6-month period were compared by resting HR.

Results

Patients with upper tertile revealed higher New York Heart Association (NYHA) class than in those with lower tertile. From the lower to the upper tertile, the incidence of composite events of death, non-fatal myocardial infarction, ischemic stroke, and hospitalization for HF were increased(3.1%, 4.4%, 16.8%, respectively; p < 0.001). Patients with upper tertile had a higher predictive value for the incidence of death (hazard ratio, 5.8; p = 0.036) and hospitalization for HF (hazard ratio, 6.4; p < 0.001) than in those with middle and lower tertile. In multivariate analysis, NYHA class III/IV, resting HR > 80/min, and ejection fraction < 35% were independent predictors of adverse events.

Conclusions

High resting HR (> 80/min) is a prognostic factor in chronic HF. Optimal treatment to reduce HR should be emphasized to improve prognosis of HF.

Keywords: Heart failure, Heart rate, Prognosis

Figures and Tables

Fig. 1

Adverse events during 6-month period according to the tertile of resting heart rate (HR). (A) Death. (B) Stroke. (C) Hospitalization for heart failure (HF). (D) All events.

Fig. 2

Event-free survival curves of death and hospitalization for heart failure (HF) according to the resting heart rate (HR). (A) Death. (B) Hospitalization for HF. CI, confidential interval.

Table 1

Clinical characteristics according to the tertile of resting heart rate

Values are presented as mean ± standard deviation or number (%).

NYHA, New York Heart Association; COPD, chronic obstructive pulmonary disease; PCI, percutaneous coronary intervention; BP, blood pressure; BPM, beats per minute; ACE, angiotensin converting enzyme; ARB, angiotensin receptor blocker.

Table 2

Multivariate analysis for prediction of 6-month outcome in patients with chronic heart failure

CI, confidential interval; NYHA, New York Heart Association.

References

1. Jessup M, Brozena S. Heart failure. N Engl J Med. 2003. 348:2007–2018.

2. Heart Failure Society of America. Lindenfeld J, Albert NM, Boehmer JP, Collins SP, Ezekowitz JA, Givertz MM, et al. HFSA 2010 comprehensive heart failure practice guideline. J Card Fail. 2010. 16:e1–e194.

3. Yoo BS. Pharmacological treatment of heart failure. Korean J Med. 2011. 81:716–719.

4. Kannel WB, Kannel C, Paffenbarger RS Jr, Cupples LA. Heart rate and cardiovascular mortality: the Framingham Study. Am Heart J. 1987. 113:1489–1494.

5. Kolloch R, Legler UF, Champion A, Cooper-Dehoff RM, Handberg E, Zhou Q, et al. Impact of resting heart rate on outcomes in hypertensive patients with coronary artery disease: findings from the International Verapamil-SR/trandolapril Study (INVEST). Eur Heart J. 2008. 29:1327–1334.

6. Fox K, Ford I, Steg PG, Tendera M, Robertson M, Ferrari R. Heart rate as a prognostic risk factor in patients with coronary artery disease and left-ventricular systolic dysfunction (BEAUTIFUL): a subgroup analysis of a randomised controlled trial. Lancet. 2008. 372:817–821.

7. Bohm M, Swedberg K, Komajda M, Borer JS, Ford I, Dubost-Brama A, et al. Heart rate as a risk factor in chronic heart failure (SHIFT): the association between heart rate and outcomes in a randomised placebo-controlled trial. Lancet. 2010. 376:886–894.

8. Perski A, Hamsten A, Lindvall K, Theorell T. Heart rate correlates with severity of coronary atherosclerosis in young postinfarction patients. Am Heart J. 1988. 116(5 Pt 1):1369–1373.

9. Kelly RP, Ting CT, Yang TM, Liu CP, Maughan WL, Chang MS, et al. Effective arterial elastance as index of arterial vascular load in humans. Circulation. 1992. 86:513–521.

10. Unverferth DV, Magorien RD, Lewis RP, Leier CV. The role of subendocardial ischemia in perpetuating myocardial failure in patients with nonischemic congestive cardiomyopathy. Am Heart J. 1983. 105:176–179.

11. Gillman MW, Kannel WB, Belanger A, D'Agostino RB. Influence of heart rate on mortality among persons with hypertension: the Framingham Study. Am Heart J. 1993. 125:1148–1154.

12. Hjalmarson A, Gilpin EA, Kjekshus J, Schieman G, Nicod P, Henning H, et al. Influence of heart rate on mortality after acute myocardial infarction. Am J Cardiol. 1990. 65:547–553.

13. Haber HL, Simek CL, Gimple LW, Bergin JD, Subbiah K, Jayaweera AR, et al. Why do patients with congestive heart failure tolerate the initiation of beta-blocker therapy? Circulation. 1993. 88(4 Pt 1):1610–1619.

14. Kaye DM, Lefkovits J, Jennings GL, Bergin P, Broughton A, Esler MD. Adverse consequences of high sympathetic nervous activity in the failing human heart. J Am Coll Cardiol. 1995. 26:1257–1263.

15. Mann DL, Kent RL, Parsons B, Cooper G 4th. Adrenergic effects on the biology of the adult mammalian cardiocyte. Circulation. 1992. 85:790–804.

16. Gullestad L, Wikstrand J, Deedwania P, Hjalmarson A, Egstrup K, Elkayam U, et al. What resting heart rate should one aim for when treating patients with heart failure with a beta-blocker? Experiences from the Metoprolol Controlled Release/Extended Release Randomized Intervention Trial in Chronic Heart Failure (MERIT-HF). J Am Coll Cardiol. 2005. 45:252–259.

17. Lechat P, Hulot JS, Escolano S, Mallet A, Leizorovicz A, Werhlen-Grandjean M, et al. Heart rate and cardiac rhythm relationships with bisoprolol benefit in chronic heart failure in CIBIS II Trial. Circulation. 2001. 103:1428–1433.

18. Flannery G, Gehrig-Mills R, Billah B, Krum H. Analysis of randomized controlled trials on the effect of magnitude of heart rate reduction on clinical outcomes in patients with systolic chronic heart failure receiving beta-blockers. Am J Cardiol. 2008. 101:865–869.

19. Choi DJ, Han S, Jeon ES, Cho MC, Kim JJ, Yoo BS, et al. Characteristics, outcomes and predictors of long-term mortality for patients hospitalized for acute heart failure: a report from the Korean heart failure registry. Korean Circ J. 2011. 41:363–371.

20. Adams KF Jr, Fonarow GC, Emerman CL, LeJemtel TH, Costanzo MR, Abraham WT, et al. Characteristics and outcomes of patients hospitalized for heart failure in the United States: rationale, design, and preliminary observations from the first 100,000 cases in the Acute Decompensated Heart Failure National Registry (ADHERE). Am Heart J. 2005. 149:209–216.

21. Cleland JG, Swedberg K, Follath F, Komajda M, Cohen-Solal A, Aguilar JC, et al. The EuroHeart Failure survey programme--a survey on the quality of care among patients with heart failure in Europe. Part 1: patient characteristics and diagnosis. Eur Heart J. 2003. 24:442–463.

22. Tsutsui H, Tsuchihashi-Makaya M, Kinugawa S, Goto D, Takeshita A. JCARE-GENERAL Investigators. Characteristics and outcomes of patients with heart failure in general practices and hospitals. Circ J. 2007. 71:449–454.

23. Kim TS, Youn HJ. From Hypertension to Heart Failure. J Korean Soc Hypertens. 2009. 15:1–11.

24. Chae SC. Angiotensin receptor blockers in high risk cardiovascular diseases. J Korean Soc Hypertens. 2008. 14:1–3.

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