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Increased Heart Rate Is Associated With Higher Mortality in Patients With Atrial Fibrillation (AF): Results From the Outcomes Registry for Better Informed Treatment of AF (ORBIT-AF).
Abstract
BACKGROUND: Most patients with atrial fibrillation (AF) require rate control; however,
the optimal target heart rate remains under debate. We aimed to assess rate control
and subsequent outcomes among patients with permanent AF. METHODS AND RESULTS: We
studied 2812 US outpatients with permanent AF in the Outcomes Registry for Better
Informed Treatment of Atrial Fibrillation. Resting heart rate was measured longitudinally
and used as a time-dependent covariate in multivariable Cox models of all-cause and
cause-specific mortality during a median follow-up of 24 months. At baseline, 7.4%
(n=207) had resting heart rate <60 beats per minute (bpm), 62% (n=1755) 60 to 79 bpm,
29% (n=817) 80 to 109 bpm, and 1.2% (n=33) ≥110 bpm. Groups did not differ by age,
previous cerebrovascular disease, heart failure status, CHA2DS2-VASc scores, renal
function, or left ventricular function. There were significant differences in race
(P=0.001), sinus node dysfunction (P=0.004), and treatment with calcium-channel blockers
(P=0.006) and anticoagulation (P=0.009). In analyses of continuous heart rates, lower
heart rate ≤65 bpm was associated with higher all-cause mortality (adjusted hazard
ratio [HR], 1.15 per 5-bpm decrease; 95% CI, 1.01 to 1.32; P=0.04). Similarly, increasing
heart rate >65 bpm was associated with higher all-cause mortality (adjusted HR, 1.10
per 5-bpm increase; 95% CI, 1.05 to 1.15; P<0.0001). This relationship was consistent
across endpoints and in a broader sensitivity analysis of permanent and nonpermanent
AF patients. CONCLUSIONS: Among patients with permanent AF, there is a J-shaped relationship
between heart rate and mortality. These data support current guideline recommendations,
and clinical trials are warranted to determine optimal rate control. CLINICAL TRIAL
REGISTRATION: URL: http://clinicaltrials.gov/. Unique identifier: NCT01165710.
Type
Journal articleSubject
atrial fibrillationheart rate
outcomes
rate control
Aged
Aged, 80 and over
Anti-Arrhythmia Agents
Atrial Fibrillation
Chi-Square Distribution
Female
Heart Rate
Humans
Male
Multivariate Analysis
Proportional Hazards Models
Prospective Studies
Registries
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
United States
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https://hdl.handle.net/10161/15003Published Version (Please cite this version)
10.1161/JAHA.115.002031Publication Info
Steinberg, Benjamin A; Kim, Sunghee; Thomas, Laine; Fonarow, Gregg C; Gersh, Bernard
J; Holmqvist, Fredrik; ... Outcomes Registry for Better Informed Treatment of Atrial
Fibrillation (ORBIT‐AF) Investigators and Patients (2015). Increased Heart Rate Is Associated With Higher Mortality in Patients With Atrial Fibrillation
(AF): Results From the Outcomes Registry for Better Informed Treatment of AF (ORBIT-AF).
J Am Heart Assoc, 4(9). pp. e002031. 10.1161/JAHA.115.002031. Retrieved from https://hdl.handle.net/10161/15003.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Eric David Peterson
Fred Cobb, M.D. Distinguished Professor of Medicine
Dr Peterson is the Fred Cobb Distinguished Professor of Medicine in the Division of
Cardiology, a DukeMed Scholar, and the Past Executive Director of the Duke Clinical
Research Institute (DCRI), Durham, NC, USA.
Dr Peterson is the Principal Investigator of the National Institute of Health, Lung
and Blood Institute (NHLBI) Spironolactone Initiation Registry Randomized Interventional
Trial in Heart Failure With Preserved Ejection Fraction (SPIRRIT) Trial He is also
the Principal I
This author no longer has a Scholars@Duke profile, so the information shown here reflects
their Duke status at the time this item was deposited.
Jonathan Paul Piccini Sr.
Professor of Medicine
Jonathan P. Piccini, MD, MHS, FACC, FAHA, FHRS is a clinical cardiac electrophysiologist
and Professor of Medicine at Duke University Medical Center and the Duke Clinical
Research Institute. He is the Director of the Cardiac Electrophysiology section at
the Duke Heart Center. His focus is on the care of patients with atrial fibrillation
and complex arrhythmias, with particular emphasis on catheter ablation and lead extraction.
His research interests include the development and evaluation of i
Laine Elliott Thomas
Professor of Biostatistics & Bioinformatics
As Deputy Director, Laine Thomas, PhD provides complementary leadership in strategy
and development of the group and DCRI. She has an outstanding record of scientific
and strategic collaboration, independent research, leadership and mentoring well known
to her colleagues at the DCRI.
Thomas joined the DCRI in 2009. She serves as Associate Director for Biostatistics
at DCRI and Associate Chair for Equity, Diversity and Inclusion within the Department
of
Alphabetical list of authors with Scholars@Duke profiles.

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