High heart rate not a negative in HFrEF with Afib

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Takeaway 

  • All-cause mortality is increased with high heart rate in patients with heart failure with reduced ejection fraction (HFrEF) who are in sinus rhythm (SR), but not for patients with HFrEF who also have Afib. 
  • Beta-blocker use did not change these outcomes.

Why this matters  

  • Heart rate has already been linked to outcomes in patients with HFrEF in SR, with a low rate associated with better prognosis, but outcomes for patients with Afib were not known.
  • In patients with heart failure with preserved ejection fraction, high beta-blocker dose plus lower heart rate are associated with a good prognosis; with Afib added in, though, tachycardia associated with reduced mortality, as seen in patients in the current study. 

Key results

  • Each 5 bpm increase in heart rate was associated with higher all-cause mortality in patients with HFrEF who were in SR (HR, 1...