Heart-rate reduction during hospitalisation and post-discharge outcomes in acute heart failure patients discharged in atrial fibrillation
T Morinaga, M Natsuaki, A Isotani, K Kanenawa, A Yajima, S Shirai, K Ando, K NodeAbstract
Background
Evidence linking in-hospital heart rate (HR) reduction to post-discharge outcomes among acute heart failure (AHF) patients with atrial fibrillation (AF) is limited.
Methods
We analyzed a single-center registry of AHF survivors and restricted the cohort to patients in AF at discharge. HR reduction was defined as admission HR > discharge HR. The primary endpoint was a discharge-anchored composite of all-cause death or HF readmission. Cox proportional-hazards models adjusted for age, sex, eGFR, discharge systolic blood pressure, prior HF hospitalization, discharge ACE/ARB, and discharge beta-blocker. We also examined ΔHR as a continuous exposure (per 10 bpm). Kaplan–Meier curves with log-rank testing were generated.
Results
We studied 182 patients (134 primary events). HR reduction was associated with a lower risk of the primary composite (adjusted hazard ratio [HR] 0.51; 95% CI 0.34–0.76; p = 0.001). When ΔHR was modeled continuously, each 10-bpm reduction was associated with lower risk (HR 0.76; 95% CI 0.62–0.93; p = 0.007). Kaplan–Meier curves separated early and remained apart over follow-up (log-rank p < 0.01).
Conclusions
In AHF patients discharged in AF, in-hospital HR reduction was independently associated with fewer post-discharge events. Consistent findings across categorical and continuous exposure analyses support HR lowering as a pragmatic in-hospital management target for this population and warrant prospective confirmation.ESC2026