Clinical Implications of Heart Rate Control in Heart Failure With Atrial Fibrillation: Multi-Center Prospective Observation Registry (CODE-AF Registry)
BackgroundAtrial fibrillation (AF) is treated by heart rate (HR) control. However, the optimal HR target in AF patients with heart failure (HF) remains unclear. To evaluate the clinical implication of the resting HR in AF patients with HF accompanied by preserved, mid-range, or reduced ejection frac...
| Main Authors: | , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2022-03-01
|
| Series: | Frontiers in Cardiovascular Medicine |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2022.787869/full |
| _version_ | 1818774448223813632 |
|---|---|
| author | Shinjeong Song Jum-Suk Ko Hye Ah Lee Eue-Keun Choi Myung-Jin Cha Tae-Hoon Kim Jin-Kyu Park Jung-Myung Lee Ki-Woon Kang Jaemin Shim Jae-Sun Uhm Jun Kim Changsoo Kim Jin-Bae Kim Hyung Wook Park Boyoung Joung Junbeom Park |
| author_facet | Shinjeong Song Jum-Suk Ko Hye Ah Lee Eue-Keun Choi Myung-Jin Cha Tae-Hoon Kim Jin-Kyu Park Jung-Myung Lee Ki-Woon Kang Jaemin Shim Jae-Sun Uhm Jun Kim Changsoo Kim Jin-Bae Kim Hyung Wook Park Boyoung Joung Junbeom Park |
| author_sort | Shinjeong Song |
| collection | DOAJ |
| description | BackgroundAtrial fibrillation (AF) is treated by heart rate (HR) control. However, the optimal HR target in AF patients with heart failure (HF) remains unclear. To evaluate the clinical implication of the resting HR in AF patients with HF accompanied by preserved, mid-range, or reduced ejection fraction (HFpEF, HFmrEF, or HFrEF, respectively).MethodsEchocardiographic data from June 2016 to April 2020 in a prospective, multicenter, observational registry from 11,104 patients were analyzed. The follow-up duration was 2.2 years. The main outcome was composite of death and hospitalization. We categorized patients according to the HF type and resting HR: ≤ 60 bpm, 61–80 bpm, 81–110 bpm, and >110 bpm.ResultsA total of 1,421 patients were enrolled in the study: 582 in the HFpEF group, 506 in the HFmrEF group, and 333 in the HFrEF group. The patients had a mean age of 69 ± 11 years and consisted of 872 (61.4%) men. Primary endpoint rates among HFpEF patients with 60 < HR ≤ 110 bpm were lower than those with HR ≤ 60 bpm (61–80 bpm group: hazard ratio, 0.66; 95% CI, 0.46–0.94; p = 0.021; 81–110 bpm group: hazard ratio, 0.60; 95% CI, 0.40–0.90; p = 0.013). Especially, HFpEF patients with HR 81–110 bpm had a lower incidence of hospitalization caused by HF aggravation than those with other HR strata (HR ≤ 80bpm strata or HR >110 bpm strata). In HFmrEF and HFrEF patients, the survival rates did not differ significantly among patients in the three groups with HR ≤ 110 bpm. Moreover, the event rates increased significantly in HFmrEF patients with HR >110 bpm (hazard ratio, 1.91; 95% CI, 1.16-3.14, p = 0.011).ConclusionIn patients with AF and HFpEF, the resting HR has U-shaped associations with the overall primary endpoint. A lower or higher resting HR is associated with increased cardiovascular outcomes, especially in patients with HFpEF and AF. |
| first_indexed | 2024-12-18T10:41:18Z |
| format | Article |
| id | doaj.art-175bfcef23f54193920b3a1e9081e2fe |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-12-18T10:41:18Z |
| publishDate | 2022-03-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-175bfcef23f54193920b3a1e9081e2fe2022-12-21T21:10:38ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2022-03-01910.3389/fcvm.2022.787869787869Clinical Implications of Heart Rate Control in Heart Failure With Atrial Fibrillation: Multi-Center Prospective Observation Registry (CODE-AF Registry)Shinjeong Song0Jum-Suk Ko1Hye Ah Lee2Eue-Keun Choi3Myung-Jin Cha4Tae-Hoon Kim5Jin-Kyu Park6Jung-Myung Lee7Ki-Woon Kang8Jaemin Shim9Jae-Sun Uhm10Jun Kim11Changsoo Kim12Jin-Bae Kim13Hyung Wook Park14Boyoung Joung15Junbeom Park16Department of Cardiology, College of Medicine, Ewha Womans University School of Medicine, Seoul, South KoreaDepartment of Cardiology, Wonkwang University School of Medicine and Hospital, Iksan, South KoreaClinical Trial Center, Mokdong Hospital, Ewha Womans University, Seoul, South KoreaDepartment of Internal Medicine, Seoul National University Hospital, Seoul, South KoreaDepartment of Internal Medicine, Seoul National University Hospital, Seoul, South KoreaDivision of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South KoreaDivision of Cardiology, Hanyang University Medical College, Seoul, South KoreaDivision of Cardiology, Kyung Hee University Medical College, Seoul, South KoreaDivision of Cardiology, Eulji University Hospital, Daejeon, South KoreaDivision of Cardiology, Korea University Anam Hospital, Seoul, South KoreaDivision of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea0Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, South Korea1Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, South KoreaDivision of Cardiology, Kyung Hee University Medical College, Seoul, South Korea2Department of Cardiovascular Medicine, Chonnam National University Medical School, Gwangju, South KoreaDivision of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South KoreaDepartment of Cardiology, College of Medicine, Ewha Womans University School of Medicine, Seoul, South KoreaBackgroundAtrial fibrillation (AF) is treated by heart rate (HR) control. However, the optimal HR target in AF patients with heart failure (HF) remains unclear. To evaluate the clinical implication of the resting HR in AF patients with HF accompanied by preserved, mid-range, or reduced ejection fraction (HFpEF, HFmrEF, or HFrEF, respectively).MethodsEchocardiographic data from June 2016 to April 2020 in a prospective, multicenter, observational registry from 11,104 patients were analyzed. The follow-up duration was 2.2 years. The main outcome was composite of death and hospitalization. We categorized patients according to the HF type and resting HR: ≤ 60 bpm, 61–80 bpm, 81–110 bpm, and >110 bpm.ResultsA total of 1,421 patients were enrolled in the study: 582 in the HFpEF group, 506 in the HFmrEF group, and 333 in the HFrEF group. The patients had a mean age of 69 ± 11 years and consisted of 872 (61.4%) men. Primary endpoint rates among HFpEF patients with 60 < HR ≤ 110 bpm were lower than those with HR ≤ 60 bpm (61–80 bpm group: hazard ratio, 0.66; 95% CI, 0.46–0.94; p = 0.021; 81–110 bpm group: hazard ratio, 0.60; 95% CI, 0.40–0.90; p = 0.013). Especially, HFpEF patients with HR 81–110 bpm had a lower incidence of hospitalization caused by HF aggravation than those with other HR strata (HR ≤ 80bpm strata or HR >110 bpm strata). In HFmrEF and HFrEF patients, the survival rates did not differ significantly among patients in the three groups with HR ≤ 110 bpm. Moreover, the event rates increased significantly in HFmrEF patients with HR >110 bpm (hazard ratio, 1.91; 95% CI, 1.16-3.14, p = 0.011).ConclusionIn patients with AF and HFpEF, the resting HR has U-shaped associations with the overall primary endpoint. A lower or higher resting HR is associated with increased cardiovascular outcomes, especially in patients with HFpEF and AF.https://www.frontiersin.org/articles/10.3389/fcvm.2022.787869/fullheart failureatrial fibrillationrate controlheart failure preserved ejection fractionU shape curve |
| spellingShingle | Shinjeong Song Jum-Suk Ko Hye Ah Lee Eue-Keun Choi Myung-Jin Cha Tae-Hoon Kim Jin-Kyu Park Jung-Myung Lee Ki-Woon Kang Jaemin Shim Jae-Sun Uhm Jun Kim Changsoo Kim Jin-Bae Kim Hyung Wook Park Boyoung Joung Junbeom Park Clinical Implications of Heart Rate Control in Heart Failure With Atrial Fibrillation: Multi-Center Prospective Observation Registry (CODE-AF Registry) Frontiers in Cardiovascular Medicine heart failure atrial fibrillation rate control heart failure preserved ejection fraction U shape curve |
| title | Clinical Implications of Heart Rate Control in Heart Failure With Atrial Fibrillation: Multi-Center Prospective Observation Registry (CODE-AF Registry) |
| title_full | Clinical Implications of Heart Rate Control in Heart Failure With Atrial Fibrillation: Multi-Center Prospective Observation Registry (CODE-AF Registry) |
| title_fullStr | Clinical Implications of Heart Rate Control in Heart Failure With Atrial Fibrillation: Multi-Center Prospective Observation Registry (CODE-AF Registry) |
| title_full_unstemmed | Clinical Implications of Heart Rate Control in Heart Failure With Atrial Fibrillation: Multi-Center Prospective Observation Registry (CODE-AF Registry) |
| title_short | Clinical Implications of Heart Rate Control in Heart Failure With Atrial Fibrillation: Multi-Center Prospective Observation Registry (CODE-AF Registry) |
| title_sort | clinical implications of heart rate control in heart failure with atrial fibrillation multi center prospective observation registry code af registry |
| topic | heart failure atrial fibrillation rate control heart failure preserved ejection fraction U shape curve |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2022.787869/full |
| work_keys_str_mv | AT shinjeongsong clinicalimplicationsofheartratecontrolinheartfailurewithatrialfibrillationmulticenterprospectiveobservationregistrycodeafregistry AT jumsukko clinicalimplicationsofheartratecontrolinheartfailurewithatrialfibrillationmulticenterprospectiveobservationregistrycodeafregistry AT hyeahlee clinicalimplicationsofheartratecontrolinheartfailurewithatrialfibrillationmulticenterprospectiveobservationregistrycodeafregistry AT euekeunchoi clinicalimplicationsofheartratecontrolinheartfailurewithatrialfibrillationmulticenterprospectiveobservationregistrycodeafregistry AT myungjincha clinicalimplicationsofheartratecontrolinheartfailurewithatrialfibrillationmulticenterprospectiveobservationregistrycodeafregistry AT taehoonkim clinicalimplicationsofheartratecontrolinheartfailurewithatrialfibrillationmulticenterprospectiveobservationregistrycodeafregistry AT jinkyupark clinicalimplicationsofheartratecontrolinheartfailurewithatrialfibrillationmulticenterprospectiveobservationregistrycodeafregistry AT jungmyunglee clinicalimplicationsofheartratecontrolinheartfailurewithatrialfibrillationmulticenterprospectiveobservationregistrycodeafregistry AT kiwoonkang clinicalimplicationsofheartratecontrolinheartfailurewithatrialfibrillationmulticenterprospectiveobservationregistrycodeafregistry AT jaeminshim clinicalimplicationsofheartratecontrolinheartfailurewithatrialfibrillationmulticenterprospectiveobservationregistrycodeafregistry AT jaesunuhm clinicalimplicationsofheartratecontrolinheartfailurewithatrialfibrillationmulticenterprospectiveobservationregistrycodeafregistry AT junkim clinicalimplicationsofheartratecontrolinheartfailurewithatrialfibrillationmulticenterprospectiveobservationregistrycodeafregistry AT changsookim clinicalimplicationsofheartratecontrolinheartfailurewithatrialfibrillationmulticenterprospectiveobservationregistrycodeafregistry AT jinbaekim clinicalimplicationsofheartratecontrolinheartfailurewithatrialfibrillationmulticenterprospectiveobservationregistrycodeafregistry AT hyungwookpark clinicalimplicationsofheartratecontrolinheartfailurewithatrialfibrillationmulticenterprospectiveobservationregistrycodeafregistry AT boyoungjoung clinicalimplicationsofheartratecontrolinheartfailurewithatrialfibrillationmulticenterprospectiveobservationregistrycodeafregistry AT junbeompark clinicalimplicationsofheartratecontrolinheartfailurewithatrialfibrillationmulticenterprospectiveobservationregistrycodeafregistry |