SynthesisEuropean journal of medical research2025
Rhythm-specific heart rate thresholds during the vulnerable period: integrated analysis for prognostic optimization in heart failure.
Synthesis in European journal of medical research, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundHeart rate control during the vulnerable period (1-3 months post-discharge) is critical for improving outcomes in heart failure (HF). Prognostic implications for sinus rhythm (SR) versus atrial fibrillation (AF) patients remain unestablished.
methodsWe conducted an observational study of 438 heart failure patients to evaluate heart rate associations with HF readmission and all-cause mortality, alongside analysis of MIMIC-III database records assessing vulnerable period mortality relationships. This primary investigation was supplemented by systematic review and meta-analysis of cohort studies and randomized trials from PubMed, Embase, and Cochrane Library databases through February 2025 examining heart rate-prognosis correlations during the vulnerable period.
resultsThe observational study demonstrated that, in SR patients, heart rates < 76 bpm at 1 month reduced mortality (P = 0.008), while 77-129 bpm increased HF readmission (P < 0.05) and composite all-cause mortality and/or HF readmission risk. AF patients with rates < 71 bpm at 3 months reduced HF readmission and or mortality (P < 0.05). MIMIC-III analysis confirmed that the mortality risk for SR increased with rates > 94 bpm (P = 0.037). Meta-analysis (6 studies) indicated elevated mortality (HR = 1.20, 95%: CI 0.98-1.46) and readmission risk (HR = 1.25, 95% CI: 0.88-1.79) at higher rates.
conclusionsMaintaining heart rates < 77 bpm (SR) and < 71 bpm (AF) during the vulnerable period reduces readmission and mortality. These thresholds provide clinically actionable guidance for rhythm-stratified heart rate management in HF.
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