Elevated Resting Heart Rate in Hospitalized Patients With Atrial Fibrillation Is Associated With Increased Cardiovascular Risk

TL;DR

Higher resting heart rates in hospitalized atrial fibrillation patients are linked to greater cardiovascular risks.

Contribution

This study identifies a specific resting heart rate threshold (80 bpm) associated with increased in-hospital risks for AF patients.

Findings

RHR exceeding 80 bpm was linked to a 79% higher risk of mortality or acute heart failure.

Advanced AF types showed higher risk across all RHR ranges.

Catheter ablation reduced risk, unlike antiarrhythmic drugs.

Abstract

Effective rate control is important in the management of atrial fibrillation (AF). However, the relationship between resting heart rate (RHR) and adverse outcomes in hospitalized patients remains uncertain.

This study was to evaluate the association between RHR and in‐hospital outcomes.

Data from the Improving Care for Cardiovascular Disease in China‐AF project from 2014 to 2019 were retrospectively analyzed. The primary outcome was the composite of in‐hospital all‐cause mortality and in‐hospital acute heart failure (AHF). Secondary outcomes included stroke/transient ischemic attack (TIA) and bleeding during hospitalization. Logistic regression analyses were used to assess the association between RHR and outcomes.

Our study included 12,775 patients hospitalized for AF in 236 hospitals. Logistic regression analyses using different models showed a significant association between RHR exceeding 80 bpm and an increased risk of the primary outcome (adjusted OR: 1.79 [95% CI: 1.44–2.22]). A positive association between RHR and the primary outcome was identified with RHR ≥ 80 bpm. Marginal effect analyses showed that patients with advanced AF types were at higher risk across the range of RHR. Conversely, catheter ablation, but not antiarrhythmic drug use, was associated with a decreased risk.

A significant association was identified between RHR and adverse outcomes in patients hospitalized for AF, where RHR exceeding 80 bpm was associated with an increased risk.

Trial Registration: ClinicalTrials.gov identifier: NCT02309398

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