Strict Versus Lenient Versus Poor Rate Control Among Patients With Atrial Fibrillation and Heart Failure (from the Get With The Guidelines – Heart Failure Program)

Paul L. Hess; Shubin Sheng; Roland Matsouaka; Adam D. DeVore; Paul A. Heidenreich; Clyde W. Yancy; Deepak L. Bhatt; Larry A. Allen; Pamela N. Peterson; P. Michael Ho; William R. Lewis; Adrian F. Hernandez; Gregg C. Fonarow; Jonathan P. Piccini

doi:10.1016/j.amjcard.2019.12.025

Strict Versus Lenient Versus Poor Rate Control Among Patients With Atrial Fibrillation and Heart Failure (from the Get With The Guidelines – Heart Failure Program)

Paul L. Hess^*, Shubin Sheng, Roland Matsouaka, Adam D. DeVore, Paul A. Heidenreich, Clyde W. Yancy, Deepak L. Bhatt, Larry A. Allen, Pamela N. Peterson, P. Michael Ho, William R. Lewis, Adrian F. Hernandez, Gregg C. Fonarow, Jonathan P. Piccini

^*Corresponding author for this work

Medicine, Cardiology Division

Research output: Contribution to journal › Article › peer-review

22 Scopus citations

Abstract

Randomized data suggest lenient rate control (resting heart rate <110 beats/min) is noninferior to strict rate control (resting heart rate <80 beats/min) in patients with atrial fibrillation (AF). However, the optimal rate control strategy in patients with AF and heart failure (HF) remains unknown. Accordingly, we performed an observational analysis using data from the Get With The Guidelines-HF Program linked with Medicare data from July 1, 2011, to September 30, 2014. Of 13,981 patients with AF and HF, 9,100 (65.0%) had strict rate control, 4,617 (33.0%) had lenient rate control, and 264 (1.9%) had poor rate control by resting heart rate on the day of discharge. After multivariable adjustment, compared with strict rate control, lenient rate control was associated with higher adjusted risks of death (hazard ratio [HR] 1.21, 95% confidence interval [CI] 1.11 to 1.33, p <0.001), all-cause readmission (HR 1.09, 95% CI 1.03 to 1.15, p <0.002), death or all-cause readmission (HR 1.11, 95% CI 1.05 to 1.18, p <0.001), but not cardiovascular readmission (HR1.08, 95% CI 1.00 to 1.16, p = 0.051) at 90 days. Associations were comparable in patients with poor rate control and with heart rate modeled as a continuous variable. The presence or absence of reduced ejection fraction did not impact the magnitude of most observed associations. In conclusion, in patients with HF and AF, 2 of 3 patients had a heart rate that met strict-control goals at discharge. Heart rates >80 beats/min were associated with adverse outcomes irrespective of left ventricular ejection fraction.

Original language	English (US)
Pages (from-to)	894-900
Number of pages	7
Journal	American Journal of Cardiology
Volume	125
Issue number	6
DOIs	https://doi.org/10.1016/j.amjcard.2019.12.025
State	Published - Mar 15 2020

Funding

Dr. Paul L. Hess discloses the following relationship: research support from the American Heart Association ( 19CDA34760126 ). Dr. Deepak L. Bhatt discloses the following relationships - Advisory Board: Cardax, Elsevier Practice Update Cardiology, Medscape Cardiology, Regado Biosciences; Board of Directors: Boston VA Research Institute, Society of Cardiovascular Patient Care; Chair: American Heart Association Quality Oversight Committee; Data Monitoring Committees: Cleveland Clinic, Duke Clinical Research Institute, Harvard Clinical Research Institute, Mayo Clinic, Mount Sinai School of Medicine, Population Health Research Institute; Honoraria: American College of Cardiology (Senior Associate Editor, Clinical Trials and News, ACC.org), Belvoir Publications (Editor in Chief, Harvard Heart Letter), Duke Clinical Research Institute (clinical trial steering committees), Harvard Clinical Research Institute (clinical trial steering committee), HMP Communications (Editor in Chief, Journal of Invasive Cardiology), Journal of the American College of Cardiology (Guest Editor; Associate Editor), Population Health Research Institute (clinical trial steering committee), Slack Publications (Chief Medical Editor, Cardiology Today's Intervention), Society of Cardiovascular Patient Care (Secretary/Treasurer), WebMD (CME steering committees); Other: Clinical Cardiology (Deputy Editor), NCDR-ACTION Registry Steering Committee (Chair), VA CART Research and Publications Committee (Chair); Research Funding: Amarin, Amgen, AstraZeneca, Bristol-Myers Squibb, Chiesi, Eisai, Ethicon, Forest Laboratories, Ironwood, Ischemix, Lilly, Medtronic, Pfizer, Roche, Sanofi Aventis, The Medicines Company; Royalties: Elsevier (Editor, Cardiovascular Intervention: A Companion to Braunwald's Heart Disease); Site Co-Investigator: Biotronik, Boston Scientific, St. Jude Medical (now Abbott); Trustee: American College of Cardiology; Unfunded Research: FlowCo, Merck, PLx Pharma, Takeda. Dr. P. Michael Ho discloses the following relationships: Steering committee for clinical trial on medication adherence (Janssen, Inc); Deputy Editor (Circulation Cardiovascular Quality and Outcomes Journal). Dr. Adam DeVore discloses the following relationships: research support from the American Heart Association, Amgen, and Novartis; consulting with Novartis.

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine

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10.1016/j.amjcard.2019.12.025

Cite this

Hess, P. L., Sheng, S., Matsouaka, R., DeVore, A. D., Heidenreich, P. A., Yancy, C. W., Bhatt, D. L., Allen, L. A., Peterson, P. N., Ho, P. M., Lewis, W. R., Hernandez, A. F., Fonarow, G. C., & Piccini, J. P. (2020). Strict Versus Lenient Versus Poor Rate Control Among Patients With Atrial Fibrillation and Heart Failure (from the Get With The Guidelines – Heart Failure Program). American Journal of Cardiology, 125(6), 894-900. https://doi.org/10.1016/j.amjcard.2019.12.025

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title = "Strict Versus Lenient Versus Poor Rate Control Among Patients With Atrial Fibrillation and Heart Failure (from the Get With The Guidelines – Heart Failure Program)",

abstract = "Randomized data suggest lenient rate control (resting heart rate <110 beats/min) is noninferior to strict rate control (resting heart rate <80 beats/min) in patients with atrial fibrillation (AF). However, the optimal rate control strategy in patients with AF and heart failure (HF) remains unknown. Accordingly, we performed an observational analysis using data from the Get With The Guidelines-HF Program linked with Medicare data from July 1, 2011, to September 30, 2014. Of 13,981 patients with AF and HF, 9,100 (65.0%) had strict rate control, 4,617 (33.0%) had lenient rate control, and 264 (1.9%) had poor rate control by resting heart rate on the day of discharge. After multivariable adjustment, compared with strict rate control, lenient rate control was associated with higher adjusted risks of death (hazard ratio [HR] 1.21, 95% confidence interval [CI] 1.11 to 1.33, p <0.001), all-cause readmission (HR 1.09, 95% CI 1.03 to 1.15, p <0.002), death or all-cause readmission (HR 1.11, 95% CI 1.05 to 1.18, p <0.001), but not cardiovascular readmission (HR1.08, 95% CI 1.00 to 1.16, p = 0.051) at 90 days. Associations were comparable in patients with poor rate control and with heart rate modeled as a continuous variable. The presence or absence of reduced ejection fraction did not impact the magnitude of most observed associations. In conclusion, in patients with HF and AF, 2 of 3 patients had a heart rate that met strict-control goals at discharge. Heart rates >80 beats/min were associated with adverse outcomes irrespective of left ventricular ejection fraction.",

author = "Hess, {Paul L.} and Shubin Sheng and Roland Matsouaka and DeVore, {Adam D.} and Heidenreich, {Paul A.} and Yancy, {Clyde W.} and Bhatt, {Deepak L.} and Allen, {Larry A.} and Peterson, {Pamela N.} and Ho, {P. Michael} and Lewis, {William R.} and Hernandez, {Adrian F.} and Fonarow, {Gregg C.} and Piccini, {Jonathan P.}",

note = "Publisher Copyright: {\textcopyright} 2019",

year = "2020",

month = mar,

day = "15",

doi = "10.1016/j.amjcard.2019.12.025",

language = "English (US)",

volume = "125",

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Hess, PL, Sheng, S, Matsouaka, R, DeVore, AD, Heidenreich, PA, Yancy, CW, Bhatt, DL, Allen, LA, Peterson, PN, Ho, PM, Lewis, WR, Hernandez, AF, Fonarow, GC & Piccini, JP 2020, 'Strict Versus Lenient Versus Poor Rate Control Among Patients With Atrial Fibrillation and Heart Failure (from the Get With The Guidelines – Heart Failure Program)', American Journal of Cardiology, vol. 125, no. 6, pp. 894-900. https://doi.org/10.1016/j.amjcard.2019.12.025

TY - JOUR

T1 - Strict Versus Lenient Versus Poor Rate Control Among Patients With Atrial Fibrillation and Heart Failure (from the Get With The Guidelines – Heart Failure Program)

AU - Hess, Paul L.

AU - Sheng, Shubin

AU - Matsouaka, Roland

AU - DeVore, Adam D.

AU - Heidenreich, Paul A.

AU - Yancy, Clyde W.

AU - Bhatt, Deepak L.

AU - Allen, Larry A.

AU - Peterson, Pamela N.

AU - Ho, P. Michael

AU - Lewis, William R.

AU - Hernandez, Adrian F.

AU - Fonarow, Gregg C.

AU - Piccini, Jonathan P.

PY - 2020/3/15

Y1 - 2020/3/15

N2 - Randomized data suggest lenient rate control (resting heart rate <110 beats/min) is noninferior to strict rate control (resting heart rate <80 beats/min) in patients with atrial fibrillation (AF). However, the optimal rate control strategy in patients with AF and heart failure (HF) remains unknown. Accordingly, we performed an observational analysis using data from the Get With The Guidelines-HF Program linked with Medicare data from July 1, 2011, to September 30, 2014. Of 13,981 patients with AF and HF, 9,100 (65.0%) had strict rate control, 4,617 (33.0%) had lenient rate control, and 264 (1.9%) had poor rate control by resting heart rate on the day of discharge. After multivariable adjustment, compared with strict rate control, lenient rate control was associated with higher adjusted risks of death (hazard ratio [HR] 1.21, 95% confidence interval [CI] 1.11 to 1.33, p <0.001), all-cause readmission (HR 1.09, 95% CI 1.03 to 1.15, p <0.002), death or all-cause readmission (HR 1.11, 95% CI 1.05 to 1.18, p <0.001), but not cardiovascular readmission (HR1.08, 95% CI 1.00 to 1.16, p = 0.051) at 90 days. Associations were comparable in patients with poor rate control and with heart rate modeled as a continuous variable. The presence or absence of reduced ejection fraction did not impact the magnitude of most observed associations. In conclusion, in patients with HF and AF, 2 of 3 patients had a heart rate that met strict-control goals at discharge. Heart rates >80 beats/min were associated with adverse outcomes irrespective of left ventricular ejection fraction.

AB - Randomized data suggest lenient rate control (resting heart rate <110 beats/min) is noninferior to strict rate control (resting heart rate <80 beats/min) in patients with atrial fibrillation (AF). However, the optimal rate control strategy in patients with AF and heart failure (HF) remains unknown. Accordingly, we performed an observational analysis using data from the Get With The Guidelines-HF Program linked with Medicare data from July 1, 2011, to September 30, 2014. Of 13,981 patients with AF and HF, 9,100 (65.0%) had strict rate control, 4,617 (33.0%) had lenient rate control, and 264 (1.9%) had poor rate control by resting heart rate on the day of discharge. After multivariable adjustment, compared with strict rate control, lenient rate control was associated with higher adjusted risks of death (hazard ratio [HR] 1.21, 95% confidence interval [CI] 1.11 to 1.33, p <0.001), all-cause readmission (HR 1.09, 95% CI 1.03 to 1.15, p <0.002), death or all-cause readmission (HR 1.11, 95% CI 1.05 to 1.18, p <0.001), but not cardiovascular readmission (HR1.08, 95% CI 1.00 to 1.16, p = 0.051) at 90 days. Associations were comparable in patients with poor rate control and with heart rate modeled as a continuous variable. The presence or absence of reduced ejection fraction did not impact the magnitude of most observed associations. In conclusion, in patients with HF and AF, 2 of 3 patients had a heart rate that met strict-control goals at discharge. Heart rates >80 beats/min were associated with adverse outcomes irrespective of left ventricular ejection fraction.

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Strict Versus Lenient Versus Poor Rate Control Among Patients With Atrial Fibrillation and Heart Failure (from the Get With The Guidelines – Heart Failure Program)

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