Heart rate as a prognostic risk factor in patients with coronary artery disease and left-ventricular systolic dysfunction (BEAUTIFUL): a subgroup analysis of a randomised controlled trial.

Description

The elevated resting heart rate at baseline as a marker for subsequent cardiovascular death and morbidity was investigated in the placebo arm of the BEAUTIFUL study. For that purpose, the authors compared patients with a baseline resting heart rate <70 bpm (n=2745) and patients with a baseline resting heart rate ≥70 bpm (n=2693). The authors reported an association between elevated heart rate and the risk of cardiovascular death and morbidity in patients with coronary artery disease and left ventricular dysfunction. In fact, patients with a baseline resting heart rate ≥70 bpm showed a 34% increased risk for cardiovascular death, a 53% and 46% increased risk, respectively, for admission to hospital for heart failure and myocardial infarction, and a 38% increased risk for coronary revascularization, after adjusting for other predictors of outcome. The authors also found that every increase of 5 bpm was associated with an 8% increase in cardiovascular death (p=0.0005), a 16% and 7% increase in admission to hospital for heart failure (p<0.0001) and myocardial infarction (p=0.052), and an 8% increase in coronary revascularization (p=0.034). They concluded that heart rate should be assessed as a prognostic marker in this population.