Optimal Heart Rate Control Improves Long-Term Prognosis of Decompensated Heart Failure with Reduced Ejection Fraction

Ming Lung Tsai, Shu I. Lin, Yu Cheng Kao, Hsuan Ching Lin, Ming Shyan Lin, Jian Rong Peng, Chao Yung Wang, Victor Chien Chia Wu, Chi Wen Cheng, Ying Hsiang Lee, Ming Jui Hung, Tien Hsing Chen*

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

3 Scopus citations


Background and Objectives: An elevated heart rate is an independent risk factor for cardiovascular disease; however, the relationship between heart rate control and the long-term outcomes of patients with heart failure with reduced ejection fraction (HFrEF) remains unclear. This study explored the long-term prognostic importance of heart rate control in patients hospitalized with HFrEF. Materials and Methods: We retrieved the records of patients admitted for decompensated heart failure with a left ventricular ejection fraction (LVEF) of ≤40%, from 1 January 2005 to 31 December 2019. The primary outcome was a composite of cardiovascular death or hospitalization for heart failure (HHF) during follow-up. We analyzed the outcomes using Cox proportional hazard ratios calculated using the patients’ heart rates, as measured at baseline and approximately 3 months later. The mean follow-up duration was 49.0 ± 38.1 months. Results: We identified 5236 eligible patients, and divided them into five groups on the basis of changes in their heart rates. The mean LVEFs of the groups ranged from 29.1% to 30.6%. After adjustment for all covariates, the results demonstrated that lesser heart rate reductions at the 3-month screening period were associated with long-term cardiovascular death, HHF, and all-cause mortality (p for linear trend = 0.033, 0.042, and 0.003, respectively). The restricted cubic spline model revealed a linear relationship between reduction in heart rate and risk of outcomes (p for nonlinearity > 0.2). Conclusions: Greater reductions in heart rate were associated with a lower risk of long-term cardiovascular death, HHF, and all-cause mortality among patients discharged after hospitalization for decompensated HFrEF.

Original languageEnglish
Article number348
JournalMedicina (Lithuania)
Issue number2
StatePublished - 12 02 2023

Bibliographical note

Publisher Copyright:
© 2023 by the authors.


  • heart failure
  • heart rate
  • mortality
  • Heart Rate
  • Ventricular Dysfunction, Left
  • Ventricular Function, Left/physiology
  • Prognosis
  • Humans
  • Heart Failure
  • Stroke Volume/physiology
  • Hospitalization


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