Effect of Heart Rate And Use of Beta Blockers on Mortality After Heart Transplantation

Heart transplantation (HT) recipients may have tachycardia secondary to cardiac denervation. As higher heart rate predicts worse outcomes in cardiovascular disease we hypothesized that tachycardia and non-use of beta blockers are associated with increased mortality post-HT. All patients who underwent HT at our institution between 1987 and 2010 were included. The association of heart rate 3 months post-HT and beta blocker use during follow-up to mortality was assessed using Kaplan-Meier and multivariable Cox proportional hazards regression analyses adjusting for clinically relevant baseline variables. Between 1987 and 2010 there were 493 HT. After excluding 29 who died within 3 months and 3 with follow-up less than 3 months, 461 HT patients (50+/-2 years; 20% women) were included. Over a follow-up of 12+/-7 years selected important univariable predictors of post-HT mortality were older age, male gender, higher BMI, ischemic cardiomyopathy, longer post-HT ICU stay and hospitalization, and at 3 months, increased mean pulmonary artery, right atrial pressure and pulmonary capillary occlusion pressure, higher heart rate, as well as non-use of beta blockers during follow-up. In multivariable analysis, older ager, longer hospitalization, higher mean pulmonary pressure, higher heart rate at 3 months (hazard ratio 1.02 per beat, 95% CI 1.008-1.035, p=0.02), and non-use of beta blockers (HR 1.43, 95% CI 1.002-2.031, p