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Heart rate at first postdischarge visit and outcomes in patients with heart failure

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Author(s)
Tae-Hun KimHyungseop KimIn-Cheol KimHyuck-Jun YoonHyoung-Seob ParkYun-Kyeong ChoChang-Wook NamSeongwook HanSeung-Ho HurYoon-Nyun Kim
Keimyung Author(s)
Kim, Hyung SeopHur, Seung HoNam, Chang WookCho, Yun KyeongPark, Hyoung SeobYoon, Hyuck JunKim, In CheolHan, Seong WookKim, Yoon Nyun
Department
Dept. of Internal Medicine (내과학)
Journal Title
Heart
Issued Date
2018
Volume
104
Issue
13
Keyword
heart failure with reduced ejection fraction
Abstract
OBJECTIVE:

Heart rate control is important to prevent adverse outcomes in patients with heart failure (HF). However, postdischarge activity may worsen heart rate control, resulting in readmission. This study aimed to explore the implications of the heart rate differences between discharge and the first outpatient visit (D-O diff).

METHODS:

We retrospectively identified 458 patients (male: 46%; mean age: 72 years) discharged after HF. The heart rates at admission, discharge and first outpatient visit were analysed. The primary outcome was a composite of cardiovascular (CV) death and readmission of non-fatal myocardial infarction (MI), non-fatal stroke or non-fatal HF over a mean follow-up of 16 months.

RESULTS:

During follow-up, the clinical outcomes were noted in 223 patients (49%): HF, 199; stroke, 9; MI, 6; CV death, 9. The heart rate at the first outpatient visit (r=-0.311, P<0.001) and D-O diff (r=0.416, P<0.001) showed a better correlation with the time-to-clinical event than the heart rate at admission or discharge. The events group displayed a pronounced heart rate increase (13 beats/min) from discharge to the first outpatient visit compared with the event-free group (a decrease of 2 beats/min). A decrease less than -15 in the D-O diff showed a 4.5-fold risk of clinical outcomes during follow-up (P<0.001).

CONCLUSIONS:

A decreased D-O diff was related to the adverse outcomes of HF. The failure of heart rate control within more than 15 beats/min at the first outpatient visit was an independent factor for CV events.
Keimyung Author(s)(Kor)
김윤년
허승호
남창욱
김형섭
조윤경
박형섭
윤혁준
김인철
한성욱
Publisher
School of Medicine (의과대학)
Citation
Tae-Hun Kim et al. (2018). Heart rate at first postdischarge visit and outcomes in patients with heart failure. Heart, 104(13), 1086–1092. doi: 10.1136/heartjnl-2017-312364
Type
Article
ISSN
1355-6037
Source
https://heart.bmj.com/content/104/13/1086.long
DOI
10.1136/heartjnl-2017-312364
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/41269
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Internal Medicine (내과학)
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