BACKGROUND In a real-world setting, the effect of pulse rate measured at the time of diagnosis and serially during follow-up and management, on outcomes in heart failure with reduced ejection fraction (HFrEF), has not been well-studied. Furthermore, how beta-blockade use in a real-world situation modifies this relation between pulse rate and outcomes in HFrEF is not well-known. Hence, we identified a large, national, real-world cohort of HFrEF to examine the association of pulse rate and outcomes. METHODS Using Veterans Affairs (VA) national electronic health records we identified incident HFrEF cases between 2006 and 2012. We examined the associations of both baseline and serially measured pulse rates, with mortality and days hospitalized per year for heart failure and for any cause, using crude and multivariable Cox proportional hazards and Poisson or negative binomial models, respectively. The exposure was examined as continuous, dichotomous, and categorical. Post-hoc analyses addressed the interaction of pulse rate and beta-blocker target dose. RESULTS We identified 51,194 incident HFrEF cases (67 ± 12 years, 98% male, 77% white. A significant positive, near linear relationship was observed for both baseline and serially measured pulse rates with all-cause mortality, all-cause hospitalization and heart failure hospitalization after adjusting for covariates including beta-blocker use. Patients who had a pulse rate ≥ 70 bpm in the past 6 months had 36% (95% CI: 31-42%), 25% (95% CI: 19-32%), and 51% (95% CI: 33-72%) increased rates of mortality, all-cause hospitalization, and heart failure hospitalization, respectively, compared to patients with pulse rates < 70 bpm. A minority of subjects (15%) were treated with guideline directed beta blockade ≥50% of recommended target dose, among whom better outcomes were seen compared to those who did not achieve target dose in patients with pulse rates both above and below 70 beats per minute. CONCLUSIONS High pulse rate, both at the time of diagnosis and during follow-up, is strongly associated with increased risk of adverse outcomes in HFrEF patients, independent of the use of beta-blockers. In a real-world setting, the majority of HFrEF patients do not achieve target dose of beta-blockade; greater use of strategies to reduce heart rate may improve outcomes in HFrEF.

中文翻译：

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心率与射血分数降低相关的心力衰竭预后的关联：一项回顾性队列研究。

背景技术在现实世界中，尚未很好地研究在诊断时以及在随访和管理期间连续测量的脉搏频率对射血分数（HFrEF）降低的心力衰竭结果的影响。此外，在现实世界中使用β受体阻滞剂如何改变HFrEF的脉搏率和预后之间的这种关系尚不清楚。因此，我们确定了一个大型的，国家级的，现实世界中的HFrEF队列，以检查脉搏率与预后的关系。方法利用退伍军人事务部（VA）的国家电子健康记录，我们确定了2006年至2012年之间发生的HFrEF事件。我们检查了基线和连续测量的脉搏率之间的关联，以及死亡率和每年因心衰和任何原因住院的天数，分别使用粗变量和多变量Cox比例风险以及泊松或负二项式模型。暴露被检查为连续的，二分的和绝对的。事后分析解决了脉搏率和β受体阻滞剂目标剂量之间的相互作用。结果我们确定了51194例HFrEF事件（67±12岁，男性98％，白人77％。）基线和连续测量的脉搏率与全因死亡率，全因住院和心脏相关均观察到显着的正近线性关系调整包括β受体阻滞剂在内的协变量后的住院失败率在过去6个月中脉率≥70 bpm的患者分别为36％（95％CI：31-42％），25％（95％CI：19-32） ％）和51％（95％CI：33-72％）分别增加死亡率，全因住院和心力衰竭住院率，与脉搏率<70 bpm的患者相比。少数受试者（15％）接受了指导性β受体阻滞≥推荐目标剂量的50％的治疗，与那些未达到目标剂量的脉搏频率高于或低于70次/次的患者相比，预后更好分钟。结论无论在诊断时还是在随访期间，高脉率都与HFrEF患者不良结局风险的增加密切相关，而与使用β受体阻滞剂无关。在现实世界中，大多数HFrEF患者未达到目标剂量的β受体阻滞剂；更多地使用降低心率的策略可能会改善HFrEF的预后。少数受试者（15％）接受了指导性β受体阻滞≥推荐目标剂量的50％的治疗，与那些未达到目标剂量的脉搏频率高于或低于70次/次的患者相比，预后更好分钟。结论无论在诊断时还是在随访期间，高脉率都与HFrEF患者不良结局风险的增加密切相关，而与使用β受体阻滞剂无关。在现实世界中，大多数HFrEF患者未达到目标剂量的β受体阻滞剂；更多地使用降低心率的策略可能会改善HFrEF的预后。少数受试者（15％）接受了指导性β受体阻滞≥推荐目标剂量的50％的治疗，与那些未达到目标剂量的脉搏频率高于或低于70次/次的患者相比，预后更好分钟。结论无论在诊断时还是在随访期间，高脉率都与HFrEF患者不良结局风险的增加密切相关，而与使用β受体阻滞剂无关。在现实世界中，大多数HFrEF患者未达到目标剂量的β受体阻滞剂；更多地使用降低心率的策略可能会改善HFrEF的预后。无论是在诊断时还是在随访期间，均与HFrEF患者不良结局风险的增加密切相关，而与使用β受体阻滞剂无关。在现实世界中，大多数HFrEF患者未达到目标剂量的β受体阻滞剂；更多地使用降低心率的策略可能会改善HFrEF的预后。无论是在诊断时还是在随访期间，均与HFrEF患者不良结局风险的增加密切相关，而与使用β受体阻滞剂无关。在现实世界中，大多数HFrEF患者未达到目标剂量的β受体阻滞剂；更多地使用降低心率的策略可能会改善HFrEF的预后。