Trial reportEuropean heart journal2013
Association between resting heart rate, chronotropic index, and long-term outcomes in patients with heart failure receiving β-blocker therapy: data from the HF-ACTION trial.
Trial report in European heart journal, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03893500 (Utility of Device and App-based Mobile Health Monitoring as a Tool for Evaluation of Clinical Response to Therapies in Pulmonary Arterial Hypertension), which is not on this map. Cited by 36 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Utility of Device and App-based Mobile Health Monitoring as a Tool for Evaluation of Clinical Response to Therapies in Pulmonary Arterial Hypertension
Who cites it
36 citing papers in PubMed.
- Outcomes of an Exercise Intervention in Adults With Down Syndrome and Congenital Heart Disease: A Secondary Analysis.Journal of intellectual disability research : JIDR · 2026Trial
- Daily physical activity and cardiorespiratory fitness in adults with Down syndrome with and without congenital heart disease.Disability and health journal · 2025Trial
- Chronotropic Incompetence Among People With HIV Improves With Exercise Training in the Exercise for Healthy Aging Study.The Journal of infectious diseases · 2024Trial
- Enhancement of bicycle exercise capacity in patients with chronotropic incompetence through closed-loop stimulation: a randomized crossover trial.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2023Trial
- Cardiopulmonary exercise test in patients with refractory angina: functional and ischemic evaluation.Clinics (Sao Paulo, Brazil) · 2022Trial
- Impact of closed loop stimulation on prognostic cardiopulmonary variables in patients with chronic heart failure and severe chronotropic incompetence: a pilot, randomized, crossover study.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2021Trial
- Effect of closed loop stimulation versus accelerometer on outcomes with cardiac resynchronization therapy: the CLASS trial.Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 2021Trial
- Vitamin DBMC cardiovascular disorders · 2017Trial
- Predictors of Higher Peak Exercise Oxygen Uptake in a Cohort of Adult Patients with Fontan Circulation.Journal of clinical medicine · 2026Article
- Chronotropic Incompetence and Cardiovascular Outcomes in Patients With Heart Failure With Preserved Ejection Fraction.Journal of the American Heart Association · 2025Article
- Activated rate-response is associated with increased mortality risk in cardiac device carriers with acute heart failure.PloS one · 2024Article
- Chronotropic Response and Risk Factors for Cardiovascular Disease in Patients with Rheumatoid Arthritis: A Cross-Sectional Study.Journal of clinical medicine · 2023Article
- Chronotropic Incompetence among People with HIV Improves with Exercise Training in the Exercise for Healthy Aging Study.medRxiv : the preprint server for health sciences · 2023Article
- Prognostic Role of Metabolic Exercise Testing in Heart Failure.Journal of clinical medicine · 2023Review
- Chronotropic Incompetence after Heart Transplantation Is Associated with Increased Mortality and Decreased Functional Capacity.Journal of clinical medicine · 2023Article
- Correlation between acylcarnitine/free carnitine ratio and cardiopulmonary exercise test parameters in patients with incident dialysis.Frontiers in physiology · 2023Article
- Beta-Adrenergic Receptor Blockade Effects on Cardio-Pulmonary Exercise Testing in Healthy Young Adults: A Randomized, Placebo-Controlled Trial.Sports medicine - open · 2022Article
- Exploring and Identifying Prognostic Phenotypes of Patients with Heart Failure Guided by Explainable Machine Learning.Life (Basel, Switzerland) · 2022Article
- Chronotropic Incompetence Limits Aerobic Exercise Capacity in Patients Taking Beta-Blockers: Real-Life Observation of Consecutive Patients.Healthcare (Basel, Switzerland) · 2021Article
- Acute Hemodynamic Index Predicts In-Hospital Mortality in Acute Decompensated Heart Failure.Arquivos brasileiros de cardiologia · 2021Observational
Corrections and comments
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Authors and funding
10 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
aimsThe aim of this study was to assess the association between resting heart rate (HR), chronotropic index (CI), and clinical outcomes in optimally treated chronic heart failure (HF) patients on β-blocker therapy. METHODS AND
resultsWe performed a sub-study in 1118 patients with HF and reduced ejection fraction (EF < 35%) included in the HF-ACTION trial. Patients in sinus rhythm who received a β-blocker and who performed with maximal effort on the exercise test were included. Chronotropic index was calculated as an index of HR reserve achieved, by using the equation (220-age) for estimating maximum HR. A sensitivity analysis using an equation developed for HF patients on β-blockers was also performed. Cox proportional hazards models were fit to assess the association between CI and clinical outcomes. Median (25th, 75th percentiles) follow-up was 32 (21, 44) months. In a multivariable model including resting HR and CI as continuous variables, neither was associated with the primary outcome of all-cause mortality or hospitalization. However, each 0.1 unit decrease in CI <0.6 was associated with 17% increased risk of all-cause mortality (hazard ratio 1.17, 95% confidence interval 1.01-1.36; P = 0.036), and 13% increased risk of cardiovascular mortality or HF hospitalization (hazard ratio 1.13, 1.02-1.26; P = 0.025). Overall, 666 of 1118 (60%) patients had a CI <0.6. Chronotropic index did not retain statistical significance when dichotomized at a value of ≤ 0.62.
conclusionIn HF patients receiving optimal medical therapy, a decrease in CI <0.6 was associated with adverse clinical outcomes. Obtaining an optimal HR response to exercise, even in patients receiving optimal β-blocker therapy, may be a therapeutic target in the HF population.
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