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Prognostic significance of remotely monitored nocturnal heart rate in heart failure patients with reduced ejection fraction

Published:October 27, 2022DOI:https://doi.org/10.1016/j.hrthm.2022.10.018

      Background

      Elevated resting heart rate is a risk factor for cardiovascular events.

      Objective

      The purpose of this study was to investigate the clinical significance of nocturnal heart rate (nHR) and 24-hour mean heart rate (24h-HR) obtained by continuous remote monitoring (RM) of implantable devices.

      Methods

      We analyzed daily-sampled trends of nHR, 24h-HR, and physical activity in patients on β-blocker therapy for chronic heart failure and with implantable cardioverter-defibrillators or cardiac resynchronization therapy defibrillators (CRT-Ds). Patients were grouped by average nHR and 24h-HR quartile during follow-up to estimate the respective incidence of nonarrhythmic death and device-treated ventricular tachycardia/fibrillation (VT/VF).

      Results

      The study cohort included 1303 patients (median age 69 years [interquartile range 61–77 years]; 41% with CRT-D; median follow-up 25 months [interquartile range 13–42 months]). Compared with patients in the lowest nHR quartile (≤57 beats/min) group, patients in the highest quartile group (>65 beats/min) had an increased risk of nonarrhythmic death (adjusted hazard ratio [AHR] 2.25; 95% confidence interval [CI] 1.13–4.50; P = .021) and VT/VF (AHR 1.98; 95% CI 1.40–2.79; P < .001) and were characterized by the lowest level of physical activity (P ≤ .0004 vs every other nHR quartiles). The highest 24h-HR quartile group (>75 beats/min) showed an increased risk of VT/VF (AHR 2.13; 95% CI 1.52–2.99; P < .001) and a weaker though significant association with nonarrhythmic mortality (AHR 1.80; 95% CI 1.00–3.22; P = .05) as compared with the lowest 24h-HR quartile group (≤65 beats/min).

      Conclusion

      In remotely monitored implantable cardioverter-defibrillator/CRT-D patients on β-blocker therapy for heart failure, elevated heart rates (nHR >65 beats/min and 24h-HR >75 beats/min) were associated with increased mortality and VT/VF risk. nHR showed a stronger association than 24h-HR with worst prognosis and lowest physical activity.

      Keywords

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