Higher heart rates at discharge linked to readmissions, death

Heart failure patients who have higher heart rates at discharge may face a higher risk of dying or being readmitted within 30 days, according to a study published online Dec. 2 in Circulation: Heart Failure.

Marlena V. Habal, MD, of the Institute for Clinical Evaluative Sciences in Toronto, and colleagues evaluated the relationship between heart rate at discharge and all-cause mortality at both 30 days and one year, death from cardiovascular causes and 30-day readmission for heart failure, ischemic heart disease and cardiovascular disease.

In a group of 9,097 hospitalized heart failure patients, the investigators categorized their discharge heart rates: 40 to 60, beats per minute, 61 to 70 beats per minute, 71 to 80 beats per minute, 81 to 90 beats per minute and greater than 90 beats per minute. The 40 to 60 group served as the reference group. The patients were all part of the previously published EFFECT-HF (Enhanced Feedback for Effective Cardiac Treatment) study that looked at whether publicly releasing data on cardiac quality measures leads hospitals to implement quality improvement measures.

All-cause mortality at 30 days was significantly higher in the group of patients with heart rates of 81 to 90 and greater than 90 when compared to the reference group (adjusted odds ratios [aORs] 1.59 and 1.56, respectively). Death from cardiovascular causes at 30 days was also higher in these groups (aORs 1.59 and 1.65).

Mortality at one year and cardiovascular-related death were significantly higher than the reference group (aORs 1.41 and 1.47). Patients with the highest heart rates also had higher rates of 30-day readmission for heart failure and cardiovascular disease (adjusted hazard ratio 1.26 and 1.29).

This relationship was present in all heart failure subgroups and was significant in the group with heart rates above 90 among patients discharged on a beta-adrenoreceptor antagonist and those with preserved left ventricular ejection fraction.

There was a non-significant increase in 30-day mortality among patients in the lowest heart rate group, which could possibly mean that a low heart rate may indicate worse short-term outcomes. However, this effect did not occur at one year, which means lower heart rates may be beneficial in some ways.

“Our study suggests that heart rate, an eminently modifiable prognostic marker, merits attention in the transition from hospital to ambulatory care in the community,” the authors wrote.