Personalized Target Heart Rate for Patients with Heart Failure and Reduced Ejection Fraction

Abstract

The optimal heart rate (HR) in patients with heart failure with reduced ejection fraction (HFrEF) has been ill-defined. Recently, a formula was proposed for estimating the target heart rate (THR), which eliminates the overlap between the E and A wave (E-A overlap). We aim to validate its prognostic significance in the multicenter WET-HF registry. This study used data from 647 patients with HFrEF hospitalized for acute decompensated HF (ADHF). The patients were divided into the 2 groups by THR. The primary endpoint was defined as the composite of all-cause death and ADHF readmission. The THR successfully discriminated the incidence of the primary endpoint, whereas no significant difference was observed in the primary endpoint when dividing the patients by uniform cutoff 70 bpm. HR at discharge ≤ THR was inversely associated with the primary endpoint. Restricted cubic spline analysis demonstrated the difference between HR at discharge, and THR (ΔHR) from −10 to ±0 was associated with a lower risk of primary endpoint and ΔHR from ±0 to +15 was associated with a higher risk. THR discriminated long-term outcomes in patients with HFrEF more efficiently than the uniform cutoff, suggesting that it may aid in tailored HR reduction strategies.

Management of heart failure patients with systolic dysfunction in a real world setting-a physician-based survey

“…A lower HR was associated with lower mortality. 31 In a retrospective study by Barwani and Petzold, reduction in resting HR to as low as ≤65 bpm was associated with improved survival from all-cause mortality among octogenarians with HFrEF and concomitant AF. 32 This observation was also evident from our survey with most physicians aiming for a target HR of 64-60 bpm.…”

A Long Road to Personalized Medicine in Heart Failure and Cardiomyopathies

“…However, the target heart rate (THR) we should aim for has not been thoroughly investigated. In order to answer this question, Yumita et al focused on the overlap between E and A waves in mitral inflow and they hypothesized that a heart rate which yields no E-A overlap might be hemodynamically ideal and could be a reasonable target [ 3 ]. This THR nicely discriminated between long-term clinical events more precisely than a uniform heart-rate cutoff (i.e., 70 bpm).…”