| Background:Heart failure(HF)is one of the global pandemics.From 2000 to 2015,the number of HF patients in China has increased by 44%,reaching 13.7 million.Among them,atrial fibrillation(AF)is the most common arrhythmia,present in up to approximately half of hospitalized HF patients,and has been shown to be associated with worse clinical outcomes.According to the current guidelines,heart rate control treatment is one of the most important treatments for HF patients with AF.Epidemiological studies have shown that elevated resting heart rate is significantly associated with increased risk of cardiovascular events among HF patients with sinus rhythm.However,among HF patients with AF,the association between heart rate and long-term clinical prognosis remains controversial,and whether this association varies across different left ventricular ejection fraction(LVEF)levels is unclear.Besides,the current guidelines recommend P-blockers as first-line treatment for heart rate control in HF patients with AF,regardless of LVEF.However,the effect of β-blocker on long-term clinical outcomes of HF patients with AF is uncertain,especially for those with preserved LVEF.Thus,this study conducted the following two analyses:Part Ⅰ:Association Between Heart Rate and 1-Year Clinical Outcomes in Heart Failure Patients with Atrial FibrillationObjective:We investigated the relationship between discharge heart rate and 1-year clinical prognosis after discharge among hospitalized HF patients with AF,and further explored this association that differ by LVEF level.Methods:Based on the China Patient-centered evaluative Assessment of Cardiac Events Prospective Heart Failure Study(China PEACE-pro-HF),we enrolled hospitalized HF patients with AF,divided them into low(<65 beats/minutes),middle(65-85 beats/minutes)and high(≥ 86 beats/minutes)heart rate groups according to discharge heart rate,and used Cox proportional hazard regression models to calculate the hazard ratios(HRs)of these heart rate groups.The primary clinical outcome was a composite outcome of all-cause death and HF rehospitalization within 1-year after discharge.Results:Among 1762 patients,724(41.1%)were women,median discharge heart rate was 75(interquartile range:69-84)beats/minutes,and 827(46.9%)had an LVEF>50%.During the 1-year follow-up,a total of 792(44.9%)individuals died or had at least one HF hospitalization.After adjusting for demographic characteristics,risk factors,comorbid diseases,anthropometric characteristics,and medications used at discharge,the groups with low[HR:1.32,95%confidence interval(CI):1.05-1.68,P=0.020]and high(HR:1.34,95%CI:1.07-1.67,P=0.009)heart rate were associated with higher risk of the primary outcome compared with the moderate group.There was a significant interaction between discharge heart rate and LVEF(Pinteraction=0.045).Among the patients with LVEF≥50%,only those with high heart rate were associated with higher risk of the primary outcome compared with the group with moderate heart rate(HR:1.38,95%CI:1.01-1.89,P=0.046),whereas there was no difference between the groups with low and moderate heart rate.Among the patients with LVEF<50%,only those with low heart rate was associated with higher risk of the primary outcome compared with the group with moderate heart rate(HR:1.46,95%CI:1.09-1.96,P=0.012);whereas there was no difference between the groups with high and moderate heart rate.Conclusions:Among the overall HF patients with AF,both low(<65 beats/minutes)and high(≥86 beats/minutes)heart rates were associated with poorer outcomes as compared with moderate(65-85 beats/minutes)heart rate.Among patients with LVEF>50%,only high heart rate was associated with higher risk;while among those with LVEF<50%,only low heart rate was associated with higher risk as compared with the group with moderate heart rate.Part Ⅱ:Association Between β-blockers and 1-Year Clinical Outcomes in Heart Failure Patients with Atrial FibrillationObjective:We investigated the relationship between the use of β-blockers at discharge and 1-year clinical prognosis after discharge among hospitalized HF patients with AF,and further explored this association that differ by LVEF level.Methods:Based on the China PEACE-pro-HF,we enrolled hospitalized HF patients with AF,divided them into two groups according to the use of β-blocker at discharge,and used Cox proportional hazard regression models to calculate the HRs of the use of β-blockers at discharge.The primary clinical outcome was a composite outcome of all-cause death and HF rehospitalization within 1-year after discharge.Results:Among 1762 patients,724(41.1%)were women,1041(56%)receivedβ-blockers at discharge,and 827(46.9%)had a LVEF>50%.During the 1-year follow-up,a total of 792(44.9%)individuals died or had at least one HF hospitalization.After adjusting for demographic characteristics,social economic status,risk factors,comorbid diseases,anthropometric characteristics,and medications used at discharge,the use ofβ-blockers at discharge was not associated with the primary outcome(HR:0.97,95%CI:0.82-1.14,P=0.687),all-cause death(HR:0.86,95%CI:0.65-1.12,P=0.256),or cardiovascular death(hazard ratio:0.76,95%CI:0.52-1.11;P=0.160).There were no significant interactions between use of β-blockers at discharge and LVEF with respect to primary outcome,all-cause death or cardiovascular death(Pinteraction>0.05).In the adjusted models,the use of β-blockers at discharge was not associated with primary outcome,all-cause death,or cardiovascular death across the different levels of LVEF:reduced(<40%),mid-range(40-49%),or preserved LVEF(≥50%).Conclusions:Among the HF patients with AF,the use of β-blockers at discharge was not associated with 1-year clinical outcomes,regardless of LVEF. |
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