Abstract
Background Although admission heart rate predicts higher mortality after acute myocardial infarction ( AMI ), less is known about discharge heart rate. We tested the hypothesis that higher discharge heart rate after AMI is related to increased long-term mortality independent of admission heart rate, and assessed whether β blockers modify this relationship. Methods and Results In 2 prospective US multicenter registries of AMI , we evaluated the associations of discharge and admission heart rate with 3-year mortality using Cox models. Among 6576 patients with AMI , discharge heart rate was modestly associated with initial heart rate ( r=0.28), comorbidities, and infarct severity. In this cohort, 10.7% did not receive β blockers at discharge. After full adjustment for demographic, psychosocial, and clinical covariates, discharge heart rate (hazard ratio [HR]=1.14 per 10 beats per minute [bpm]; 95% CI =1.07-1.21 per 10 bpm) was more strongly associated with risk of death than admission heart rate (HR=1.05 per 10 bpm; 95% CI=1.02-1.09 per 10 bpm) when both were entered in the same model ( P=0.043 for comparison). There was a significant interaction between discharge heart rate and β-blocker use ( P=0.004) on mortality, wherein risk of death was markedly higher among those with high discharge heart rate and not on β blockers (HR=1.35 per 10 bpm; 95% CI=1.19-1.53 per 10 bpm) versus those with a high discharge heart rate and on β blockers at discharge (HR=1.10 per 10 bpm; 95% CI=1.03-1.17 per 10 bpm). Conclusions Higher discharge heart rate after AMI was more strongly associated with 3-year mortality than admission heart rate, and the risk associated with higher discharge heart rate was modified by β blockers at discharge. These findings highlight opportunities for risk stratification and intervention that will require further investigation.
| Original language | English (US) |
|---|---|
| Pages (from-to) | e010855 |
| Journal | Journal of the American Heart Association |
| Volume | 8 |
| Issue number | 3 |
| DOIs | |
| State | Published - Feb 5 2019 |
| Externally published | Yes |
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Keywords
- discharge
- mortality
- myocardial infarction
- β blocker
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
Cite this
Discharge Heart Rate After Hospitalization for Myocardial Infarction and Long-Term Mortality in 2 US Registries. / Alapati, Venkatesh; Tang, Fengming; Charlap, Esti; Chan, Paul S.; Heidenreich, Paul A.; Jones, Philip G.; Spertus, John A.; Srinivas, Vankeepuram; Kizer, Jorge.
In: Journal of the American Heart Association, Vol. 8, No. 3, 05.02.2019, p. e010855.Research output: Contribution to journal › Article
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TY - JOUR
T1 - Discharge Heart Rate After Hospitalization for Myocardial Infarction and Long-Term Mortality in 2 US Registries
AU - Alapati, Venkatesh
AU - Tang, Fengming
AU - Charlap, Esti
AU - Chan, Paul S.
AU - Heidenreich, Paul A.
AU - Jones, Philip G.
AU - Spertus, John A.
AU - Srinivas, Vankeepuram
AU - Kizer, Jorge
PY - 2019/2/5
Y1 - 2019/2/5
N2 - Background Although admission heart rate predicts higher mortality after acute myocardial infarction ( AMI ), less is known about discharge heart rate. We tested the hypothesis that higher discharge heart rate after AMI is related to increased long-term mortality independent of admission heart rate, and assessed whether β blockers modify this relationship. Methods and Results In 2 prospective US multicenter registries of AMI , we evaluated the associations of discharge and admission heart rate with 3-year mortality using Cox models. Among 6576 patients with AMI , discharge heart rate was modestly associated with initial heart rate ( r=0.28), comorbidities, and infarct severity. In this cohort, 10.7% did not receive β blockers at discharge. After full adjustment for demographic, psychosocial, and clinical covariates, discharge heart rate (hazard ratio [HR]=1.14 per 10 beats per minute [bpm]; 95% CI =1.07-1.21 per 10 bpm) was more strongly associated with risk of death than admission heart rate (HR=1.05 per 10 bpm; 95% CI=1.02-1.09 per 10 bpm) when both were entered in the same model ( P=0.043 for comparison). There was a significant interaction between discharge heart rate and β-blocker use ( P=0.004) on mortality, wherein risk of death was markedly higher among those with high discharge heart rate and not on β blockers (HR=1.35 per 10 bpm; 95% CI=1.19-1.53 per 10 bpm) versus those with a high discharge heart rate and on β blockers at discharge (HR=1.10 per 10 bpm; 95% CI=1.03-1.17 per 10 bpm). Conclusions Higher discharge heart rate after AMI was more strongly associated with 3-year mortality than admission heart rate, and the risk associated with higher discharge heart rate was modified by β blockers at discharge. These findings highlight opportunities for risk stratification and intervention that will require further investigation.
AB - Background Although admission heart rate predicts higher mortality after acute myocardial infarction ( AMI ), less is known about discharge heart rate. We tested the hypothesis that higher discharge heart rate after AMI is related to increased long-term mortality independent of admission heart rate, and assessed whether β blockers modify this relationship. Methods and Results In 2 prospective US multicenter registries of AMI , we evaluated the associations of discharge and admission heart rate with 3-year mortality using Cox models. Among 6576 patients with AMI , discharge heart rate was modestly associated with initial heart rate ( r=0.28), comorbidities, and infarct severity. In this cohort, 10.7% did not receive β blockers at discharge. After full adjustment for demographic, psychosocial, and clinical covariates, discharge heart rate (hazard ratio [HR]=1.14 per 10 beats per minute [bpm]; 95% CI =1.07-1.21 per 10 bpm) was more strongly associated with risk of death than admission heart rate (HR=1.05 per 10 bpm; 95% CI=1.02-1.09 per 10 bpm) when both were entered in the same model ( P=0.043 for comparison). There was a significant interaction between discharge heart rate and β-blocker use ( P=0.004) on mortality, wherein risk of death was markedly higher among those with high discharge heart rate and not on β blockers (HR=1.35 per 10 bpm; 95% CI=1.19-1.53 per 10 bpm) versus those with a high discharge heart rate and on β blockers at discharge (HR=1.10 per 10 bpm; 95% CI=1.03-1.17 per 10 bpm). Conclusions Higher discharge heart rate after AMI was more strongly associated with 3-year mortality than admission heart rate, and the risk associated with higher discharge heart rate was modified by β blockers at discharge. These findings highlight opportunities for risk stratification and intervention that will require further investigation.
KW - discharge
KW - mortality
KW - myocardial infarction
KW - β blocker
UR - http://www.scopus.com/inward/record.url?scp=85060640615&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85060640615&partnerID=8YFLogxK
U2 - 10.1161/JAHA.118.010855
DO - 10.1161/JAHA.118.010855
M3 - Article
C2 - 30691334
AN - SCOPUS:85060640615
VL - 8
SP - e010855
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
SN - 2047-9980
IS - 3
ER -