PT  - JOURNAL ARTICLE
AU  - Giorgio Moschovitis
AU  - Linda S B Johnson
AU  - Steffen Blum
AU  - Stefanie Aeschbacher
AU  - Maria Luisa De Perna
AU  - Alberto Pagnamenta
AU  - Patrizia Assunta Mayer Melchiorre
AU  - Alexander P Benz
AU  - Richard Kobza
AU  - Marcello Di Valentino
AU  - Christine S Zuern
AU  - Angelo Auricchio
AU  - Giulio Conte
AU  - Nicolas Rodondi
AU  - Manuel R Blum
AU  - Juerg H Beer
AU  - Michael Kühne
AU  - Stefan Osswald
AU  - David Conen
ED  - ,
TI  - Heart rate and adverse outcomes in patients with prevalent atrial fibrillation
AID  - 10.1136/openhrt-2021-001606
DP  - 2021 Apr 01
TA  - Open Heart
PG  - e001606
VI  - 8
IP  - 1
4099  - http://openheart.bmj.com/content/8/1/e001606.short
4100  - http://openheart.bmj.com/content/8/1/e001606.full
SO  - Open Heart2021 Apr 01; 8
AB  - Objective The optimal target heart rate in patients with prevalent atrial fibrillation (AF) is not well defined. The aim of this study was to analyse the associations between heart rate and adverse outcomes in a large contemporary cohort of patients with prevalent AF.Methods From two prospective cohort studies, we included stable AF outpatients who were in AF on the baseline ECG. The main outcome events assessed during prospective follow-up were heart failure hospitalisation, stroke or systemic embolism and death. The associations between heart rate and adverse outcomes were evaluated using multivariable Cox regression models.Results The study population consisted of 1679 patients who had prevalent AF at baseline. Mean age was 74 years, and 24.6% were women. The mean heart rate on the baseline ECG was 78 (±19) beats per minute (bpm). The median follow-up was 3.9 years (IQR 2.2–5.0). Heart rate was not significantly associated with heart failure hospitalisation (adjusted HR (aHR) per 10 bpm increase, 1.00, 95% CI 0.94 to 1.07, p=0.95), stroke or systemic embolism (aHR 0.95, 95% CI 0.84 to 1.07, p=0.38) or death (aHR 1.02, 95% CI 0.95 to 1.09, p=0.66). There was no evidence of a threshold effect for heart rates <60 bpm or >100 bpm.Conclusions In this large contemporary cohort of outpatients with prevalent AF, we found no association between heart rate and adverse outcome events. These data are in line with recommendations that strict heart rate control is not needed in otherwise stable outpatients with AF.No data are available.