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Clinical Implications of Heart Rate Control in Heart Failure With Atrial Fibrillation: Multi-Center Prospective Observation Registry (CODE-AF Registry)

  • 주제(키워드) heart failure , atrial fibrillation , rate control , heart failure preserved ejection fraction , U shape curve
  • 주제(기타) Cardiac & Cardiovascular Systems
  • 설명문(일반) [Song, Shinjeong; Park, Junbeom] Ewha Womans Univ, Coll Med, Dept Cardiol, Sch Med, Seoul, South Korea; [Ko, Jum-Suk] Wonkwang Univ, Dept Cardiol, Sch Med & Hosp, Iksan, South Korea; [Lee, Hye Ah] Ewha Womans Univ, Mokdong Hosp, Clin Trial Ctr, Seoul, South Korea; [Choi, Eue-Keun; Cha, Myung-Jin] Seoul Natl Univ Hosp, Dept Internal Med, Seoul, South Korea; [Kim, Tae-Hoon; Uhm, Jae-Sun; Joung, Boyoung] Yonsei Univ, Coll Med, Div Cardiol, Dept Internal Med, Seoul, South Korea; [Park, Jin-Kyu] Hanyang Univ, Div Cardiol, Coll Med, Seoul, South Korea; [Lee, Jung-Myung; Kim, Jin-Bae] Kyung Hee Univ, Div Cardiol, Coll Med, Seoul, South Korea; [Kang, Ki-Woon] Eulji Univ Hosp, Div Cardiol, Daejeon, South Korea; [Shim, Jaemin] Korea Univ, Div Cardiol, Anam Hosp, Seoul, South Korea; [Kim, Jun] Univ Ulsan, Dept Internal Med, Coll Med, Seoul, South Korea; [Kim, Changsoo] Yonsei Univ, Dept Prevent Med, Coll Med, Seoul, South Korea; [Park, Hyung Wook] Chonnam Natl Univ, Dept Cardiovasc Med, Sch Med, Gwangju, South Korea
  • 등재 SCIE, SCOPUS
  • OA유형 Green Published, gold
  • 발행기관 FRONTIERS MEDIA SA
  • 발행년도 2022
  • 총서유형 Journal
  • URI http://www.dcollection.net/handler/ewha/000000190891
  • 본문언어 영어
  • Published As https://doi.org/10.3389/fcvm.2022.787869
  • PubMed https://pubmed.ncbi.nlm.nih.gov/35391851

초록/요약

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.

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