Usefulness of Heart Rate at Rest as a Predictor of Mortality, Hospitalization for Heart Failure, Myocardial Infarction, and Stroke in Patients With Stable Coronary Heart Disease (Data from the Treating to New Targets [TNT] Trial)

The heart rate at rest (HR) is a predictor of cardiovascular (CV) mortality. However, its effect on nonfatal CV events is unknown. The aim of the present post hoc analysis of the Treating New Targets (TNT) trial was to assess the effect of the HR at rest on major CV events in patients with stable co...

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Bibliographic Details
Published in:The American journal of cardiology Vol. 105; no. 7; pp. 905 - 911
Main Authors: Ho, Jennifer E., Bittner, Vera, DeMicco, David A., Breazna, Andrei, Deedwania, Prakash C., Waters, David D.
Format: Journal Article
Language:English
Published: New York, NY Elsevier Inc 01.04.2010
Elsevier
Elsevier Limited
Subjects:
Biological and medical sciences
Cardiology
Cardiology. Vascular system
Cardiovascular
Cardiovascular disease
Coronary Disease - complications
Coronary heart disease
Female
Follow-Up Studies
Heart
Heart failure
Heart Failure - etiology
Heart Failure - mortality
Heart failure, cardiogenic pulmonary edema, cardiac enlargement
Heart Rate
Hospitalization
Humans
Male
Medical sciences
Middle Aged
Mortality
Myocardial Infarction - etiology
Myocardial Infarction - mortality
Myocarditis. Cardiomyopathies
Neurology
Rest
Stroke
Stroke - etiology
Stroke - mortality
Vascular diseases and vascular malformations of the nervous system
Human
Myocardial infarction
Heart failure
Nervous system diseases
Stroke
Prognosis
Predictor
Mortality
Cardiovascular disease
Patient
Data
Hospitalization
Myocardial disease
Coronary heart disease
Cerebral disorder
Vascular disease
Heart rate
Rest
Treatment
Central nervous system disease
Circulatory system
Cardiology
Predictive factor
Cerebrovascular disease
ISSN:0002-9149, 1879-1913, 1879-1913
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Summary:The heart rate at rest (HR) is a predictor of cardiovascular (CV) mortality. However, its effect on nonfatal CV events is unknown. The aim of the present post hoc analysis of the Treating New Targets (TNT) trial was to assess the effect of the HR at rest on major CV events in patients with stable coronary heart disease. A total of 9,580 subjects were included in the present analysis and were followed up for a median of 4.9 years. The rate of major CV events was 11.9% in those with a baseline HR of ≥70 beats/min versus 8.8% in those with a baseline HR of <70 beats/min. An increased HR at rest was associated with CV events, even after adjustment for differences in baseline characteristics (unadjusted hazard ratio 1.16 for every 10-beats/min increase, 95% confidence interval [CI] 1.10 to 1.23, p <0.0001; adjusted hazard ratio 1.08 per 10-beats/min increase, 95% CI 1.02 to 1.16, p = 0.018). A HR ≥70 beats/min was a significant independent predictor of all-cause mortality (hazard ratio 1.40, 95% CI 1.14 to 1.71, p = 0.001) and heart failure hospitalization (hazard ratio 2.30, 95% CI 1.80 to 2.95, p ≥0.0001). However, this association was not observed for stroke or myocardial infarction (p = 0.11 and p = 0.68, respectively). In conclusion, in patients with stable coronary heart disease, every 10-beats/min increase in the HR at rest was associated with an 8% increase in major CV events. In particular, a HR at rest of ≥70 beats/min was associated with a 40% increased risk of all-cause mortality and more than doubled the risk of heart failure hospitalization, but not the risk of stroke or myocardial infarction.
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ISSN:0002-9149
1879-1913
1879-1913
DOI:10.1016/j.amjcard.2009.11.035