AimsResting heart rate (HR) is a strong risk marker in patients with heart failure (HF), but the clinical implications of visit‐to‐visit changes in HR (ΔHR) are less well established. We aimed to explore the association between ΔHR and subsequent outcomes in a pooled dataset of two well‐characterized cohorts of patients with HF across the full range of left ventricular ejection fraction (LVEF).Methods and resultsPARADIGM‐HF and PARAGON‐HF were randomized trials testing sacubitril/valsartan versus enalapril or valsartan, respectively, in patients with HF and LVEF ≤40% (PARADIGM‐HF) or LVEF ≥45% (PARAGON‐HF). We analysed the association between ΔHR from the preceding visit with the primary endpoint of HF hospitalization (HFH) or cardiovascular death using covariate‐adjusted Cox proportional hazards models. A total of 13 194 patients (mean age 67 ± 11 years, 67% men, mean LVEF 40 ± 15%) were included. Over a median follow‐up of 2.5 years, 3114 patients experienced a first HFH or cardiovascular death event (10.4 events per 100 patient‐years). An increase in HR from the preceding visit, compared with no change, was associated with a higher risk (hazard ratio 1.12; 95% confidence interval [CI] 1.10–1.15; p < 0.001 per 5 bpm increase). Conversely, a drop in HR was associated with a lower risk (hazard ratio 0.97; 95% CI 0.94–1.00; p = 0.044 per 5 bpm drop). The prognostic implications of ΔHR were consistent across the range of LVEF and observed regardless of β‐blocker use or presence of a permanent pacemaker. Visit‐to‐visit increases in HR were especially prognostic in patients without atrial fibrillation (pinteraction = 0.006).ConclusionAcross a broad spectrum of patients with chronic HF, increases in HR from a preceding visit independently predicted clinical outcomes. The detection of notable increases in HR between outpatient visits may help identify patients at heightened risk of adverse events.Clinical Trial Registration; ClinicalTrials.gov NCT01035255 (PARADIGM‐HF), NCT01920711 (PARAGON‐HF).

中文翻译：

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心力衰竭心率的就诊间变化：PARADIGM-HF 和 PARAGON-HF 试验的汇总参与者水平分析


目的静息心率 （HR） 是心力衰竭 （HF） 患者的强风险标志物，但 HR 的就诊变化 （ΔHR） 的临床意义尚不明确。我们旨在探索 ΔHR 与后续结果之间的关联，该数据集包含两个特征明确的 HF 患者队列，涵盖整个左心室射血分数 （LVEF）。方法和结果PARADIGM-HF 和 PARAGON-HF 是随机试验，分别在 HF 和 LVEF ≤40% （PARADIGM-HF） 或 LVEF ≥45% （PARAGON-HF） 患者中测试沙库巴曲/缬沙坦与依那普利或缬沙坦。我们使用协变量调整的 Cox 比例风险模型分析了上次就诊的 ΔHR 与 HF 住院 （HFH） 或心血管死亡的主要终点之间的关联。共纳入 13 194 例患者 （平均年龄 67 ± 11 岁，67% 为男性，平均 LVEF 40 ± 15%）。在中位 2.5 年的随访中，3114 名患者经历了首次 HFH 或心血管死亡事件 （每 100 患者年 10.4 次事件）。与无变化相比，HR 比上次就诊增加与更高的风险相关（风险比 1.12;95% 置信区间 [CI] 1.10–1.15;p < 每增加 5 次/分 0.001）。相反，HR 下降与较低的风险相关 （风险比 0.97;95% CI 0.94–1.00;p = 0.044/5 bpm 下降）。ΔHR 的预后影响在 LVEF 范围内是一致的，并且无论是否使用 β 阻滞剂或存在永久性起搏器都可以观察到。在无心房颤动的患者中，HR 的就诊次数增加尤其预后 （pinteraction = 0.006）。结论在广泛的慢性 HF 患者中，与先前就诊相比，HR 的增加独立预测了临床结果。 在门诊就诊之间检测到 HR 的显着增加可能有助于识别不良事件风险较高的患者。临床试验注册;ClinicalTrials.gov NCT01035255 （PARADIGM-HF），NCT01920711 （PARAGON-HF）。