Discharge heart rate and 1-year clinical outcomes in heart failure patients with atrial fibrillation

Background: The association between heart rate and 1-year clinical outcomes in heart failure (HF) patients with atrial fibrillation (AF), and whether this association depends on left ventricular ejection fraction (LVEF), are unclear. We investigated the relationship between discharge heart rate and 1-year clinical outcomes after discharge among hospitalized HF patients with AF, and further explored this association that differ by LVEF level.Methods: In this analysis, we enrolled 1760 hospitalized HF patients with AF from the China Patient-centered Evaluative Assessment of Cardiac Events Prospective Heart Failure study from August 2016 to May 2018. Patients were categorized into three groups with low (<65 beats per minute [bpm]), moderate (65-85 bpm), and high (≥86 bpm) heart rate measured at discharge.Cox proportional hazard models were employed to explore the association between heart rate and 1-year primary outcome, which was defined as a composite outcome of all-cause death and HF rehospitalization.Results: Among 1760 patients, 723 (41.1%) were women, the median age was 69 (interquartile range [IQR]: 60-77) years, median discharge heart rate was 75 (IQR: 69-84) bpm, and 934 (53.1%) had an LVEF <50%. During 1-year follow-up, a total of 792 (45.0%) individuals died or had at least one HF hospitalization. After adjusting for demographic characteristics, smoking status, medical history, anthropometric characteristics, and medications used at discharge, the groups with low (hazard ratio [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 a higher risk of 1-year primary outcome compared with the moderate group. A significant interaction between discharge heart rate and LVEF for the primary outcome was observed (P for interaction was 0.045). Among the patients with LVEF ≥50%, only those with high heart rate were associated with a higher risk of 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 were associated with a higher risk of 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 bpm) and high (≥86 bpm) heart rates were associated with poorer outcomes as compared with moderate (65-85 bpm) heart rate. Among patients with LVEF ≥50%, only a high heart rate was associated with higher risk;while among those with LVEF <50%, only a low heart rate was associated with higher risk as compared with the group with moderate heart rate.Trail Registration: Clinicaltrials.gov;NCT02878811.

中国急性心肌梗死患者教育程度与预后的关联分析

目的中国是人口多样化、教育程度差异很大的国家,然而教育程度与我国急性心肌梗死(AMI)患者预后的相关性仍不清楚。本研究旨在探索AMI患者的教育程度与预后的相关性,以期进一步指导未来健康医疗干预的方向。方法研究基于China PEACE前瞻性AMI研究的数据,共纳入来自中国53家医院的3 369名连续入选的AMI患者,并根据其接受教育的程度分为高(高中、大学及研究生)、中(初中学位)、低(小学及小学以下)3个不同水平。采用生存模型分析不同教育程度与AMI后1年严重心血管病不良事件(MACE)发生率和全因病死率的关系,并校正了人口统计学和心血管危险因素等差异的影响。结果研究人群的中位年龄为61(52~69)岁,23.2%为女性,33.3%为高学历水平,32.4%为中等学历水平,34.3%为低学历水平。与高中、大学或研究生学历相比,小学或小学以下学历患者的1年MACE发生率更高(危害比2.41, 95%可信区间1.72~3.37),全因病死率也显著增高(危害比3.09, 95%可信区间1.69~5.65)。在校正人口统计学及共病因素后,教育程度与1年全因病死率的关联减弱(危害比1.41, 95%可信区间0.74~2.69, P=0.30),但教育程度与AMI后1年MACE的关联仍有统计学意义,且学历低的患者的不良事件发生风险是学历高者的近1.7倍(调整危害比1.68, 95%可信区间1.18~2.41, P=0.004)。结论在中国AMI住院患者人群中,教育程度较低的患者在AMI发病1年内发生不良心血管事件和全因死亡的风险更高。将来对AMI患者的健康干预应根据其教育程度的不同,有针对性地完善出院后的宣教和护理,以期改善患者预后。临床试验注册号NCT01624909。