International Journal of Heart Failure

The Korean Society of Heart Failure (대한심부전학회)
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Differences in the Effects of Beta-Blockers Depending on Heart Rate at Discharge in Patients With Heart Failure With Preserved Ejection Fraction and Atrial Fibrillation

  • Young In Kim (Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine) ;
  • Min-Soo Ahn (Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine) ;
  • Byung-Su Yoo (Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine) ;
  • Jang-Young Kim (Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine) ;
  • Jung-Woo Son (Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine) ;
  • Young Jun Park (Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine) ;
  • Sung Hwa Kim (Center of Biomedical Data Science, Yonsei University Wonju College of Medicine) ;
  • Dae Ryong Kang (Center of Biomedical Data Science, Yonsei University Wonju College of Medicine) ;
  • Hae-Young Lee (Department of Internal Medicine, Seoul National University Hospital) ;
  • Seok-Min Kang (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Myeong-Chan Cho (Chungbuk National University College of Medicine)
  • Received : 2023.09.15
  • Accepted : 2024.06.25
  • Published : 2024.07.30
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Abstract

Background and Objectives: Beta-blockers (BBs) improve prognosis in heart failure (HF), which is mediated by lowering heart rate (HR). However, HR has no prognostic implication in atrial fibrillation (AF) and also BBs have not been shown to improve prognosis in heart failure with preserved ejection fraction (HFpEF) with AF. This study assessed the prognostic implication of BB in HFpEF with AF according to discharge HR. Methods: From the Korean Acute Heart Failure Registry, 687 patients with HFpEF and AF were selected. Study subjects were divided into 4 groups based on 75 beats per minute (bpm) of HR at discharge and whether or not they were treated with BB at discharge. Results: Of the 687 patients with HFpEF and AF, 128 (36.1%) were in low HR group and 121 (36.4%) were in high HR group among those treated with BB at discharge. In high HR group, HR at discharge was significantly faster in BB non-users (85.5±9.1 bpm vs. 89.2±12.5 bpm, p=0.005). In the Cox model, BB did not improve 60-day rehospitalization (hazard ratio, 0.93;95% confidence interval [95% CI], 0.35-2.47) or mortality (hazard ratio, 0.77; 95% CI, 0.22-2.74) in low HR group. However, in high HR group, BB treatment at discharge was associated with 82% reduced 60-day HF rehospitalization (hazard ratio, 0.18; 95% CI, 0.04-0.81), but not with mortality (hazard ratio, 0.77; 95% CI, 0.20-2.98). Conclusions: In HFpEF with AF, in patients with HR over 75 bpm at discharge, BB treatment at discharge was associated with a reduced 60-day rehospitalization rate.

Keywords

Acknowledgement

This work was supported by Research of Korea Centers for Disease Control and Prevention (grant No. 2010-E63003-00,2011-E63002-00, 2012-E63005-00, 2013-E63003-00, 2013-E63003-01, 2013-E63003-02, and 2016-ER6303-00) and Gangwon branch of the Korean Society of Cardiology (grant No. GAH2022-02-02).

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