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 1330 patients (median age 69 years [interquartile range 61–77 years]; 41% [n = 550] 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 patients with implantable cardioverter-defibrillator/CRT-D 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.
Prognostic significance of remotely monitored nocturnal heart rate in heart failure patients with reduced ejection fraction / D'Onofrio, A.; Marini, M.; Rovaris, G.; Zanotto, G.; Calvi, V.; Iacopino, S.; Biffi, M.; Solimene, F.; Della Bella, P.; Caravati, F.; Pisano, E. C.; Amellone, C.; D'Alterio, G.; Pedretti, S.; Santobuono, V. E.; Russo, A. D.; Nicolis, D.; De Salvia, A.; Baroni, M.; Quartieri, F.; Manzo, M.; Rapacciuolo, A.; Saporito, D.; Maines, M.; Marras, E.; Bontempi, L.; Morani, G.; Giacopelli, D.; Gargaro, A.; Giammaria, M.. - In: HEART RHYTHM. - ISSN 1547-5271. - 20:2(2023), pp. 233-240. [10.1016/j.hrthm.2022.10.018]
Prognostic significance of remotely monitored nocturnal heart rate in heart failure patients with reduced ejection fraction
Solimene F.;Quartieri F.;Rapacciuolo A.;
2023
Abstract
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 1330 patients (median age 69 years [interquartile range 61–77 years]; 41% [n = 550] 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 patients with implantable cardioverter-defibrillator/CRT-D 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.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
