Prognostically Optimal Heart Rate at Discharge in Hospitalized Patients With Heart Failure and Atrial Fibrillation

Managing heart rate (HR) is crucial for enhancing clinical prognosis in patients with heart failure (HF) and atrial fibrillation (AF). Nevertheless, the prognostic impact of HR at discharge in hospitalized HF patients remains unclear. This study aimed to determine the HR associated with the lowest risk of death and HF in patients hospitalized with HF and AF. In this observational study, 334 persistent AF patients were analyzed from a database of 1,930 consecutive HF hospitalizations. Exclusion criteria included sinus rhythm or paroxysmal AF, cardiac pacemakers, or unrecorded HR at discharge. Participants were divided into 4 groups based on HR at discharge in 10 beats/min increments. The primary endpoint was a composite of death from any cause and rehospitalization due to HF. The association between resting HR and the primary endpoint was determined using Kaplan-Meier analysis and Cox proportional hazards models. The median follow-up period was 389 days, with 133 patients (39.8%) reaching the primary endpoint. Kaplan-Meier analysis revealed a significantly higher primary endpoint incidence in patients with HR >81 beats/min at discharge compared to those with HR 81 beats/min at discharge was associated with the primary endpoint, with a hazard ratio of 1.79 (95% CI: 1.04-3.07), compared to HR