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
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
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DOI：
10.1161/circheartfailure.115.002285
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发表时间：
2015-09-01
影响因子：
9.7
通讯作者：
Fu, Michael
中科院分区：
文献类型：
--
作者：
Li, Shi-Jun;Sartipy, Ulrik;Fu, Michael
背景 在心力衰竭和射血分数降低的情况下，心率 (HR) 在心房颤动 (AF) 中的预后作用尚不清楚，并且β受体阻滞剂在 AF 中的有效性最近受到质疑。 方法和结果 本研究纳入了在瑞典心力衰竭登记处登记的总共 18 858 例心力衰竭和射血分数降低的患者：窦性心律患者 (SR；n=11 466) 和 AF 患者 (n=7392)。结果指标是全因死亡率。与HR 60次/分钟相比，SR的死亡率调整后风险比分别为：HR=61～70次/分钟为1.26、HR=71～80次/分钟为1.37、HR=81～90次/分钟为1.52、HR=91～100次/分钟为1.63、HR>100次/分钟为2.69。然而，在 AF 中，风险比仅在 HR >100 次/分钟时增加 (1.30；P=0.001)。与 HR 每分钟 60 次相比，β-受体阻滞剂的使用与 SR（风险比，0.77；P=0.011）和 AF（风险比，071；P100 次/分钟（1.29；P=0.003））死亡率降低相关。 结论 在心力衰竭和射血分数降低的患者中，较高的 HR 与 SR 死亡率增加相关，但在 AF 中，这种情况仅适用于 HR >100 次/分钟的β受体阻滞剂的使用与 SR 和 AF 的死亡率降低相关。
Background In heart failure and reduced ejection fraction, the prognostic role of heart rate (HR) in atrial fibrillation (AF) is unknown and the effectiveness of -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). -blocker use was associated with reduced mortality in SR (hazard ratio, 0.77; P=0.011) and in AF (hazard ratio, 071; P100 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. -blocker use was associated with reduced mortality both in SR and in AF.