Differential Prognostic Impact of Resting Heart Rate in Older Compared With Younger Patients With Chronic Heart Failure—Insights From TIME-CHF

• The prognostic role of heart rate (HR) in older heart failure patients is unknown.
• We compared the effects of HR on 18-month outcomes between older and younger patients in TIME-CHF.
• Older patients with lower and higher baseline HRs had similar outcomes.
• Younger patients with higher HR had worse outcomes than those with lower HR.
• In contrast to younger patients, HR may not be a prognostic marker in older heart failure patients

BackgroundThere is little information regarding the prognostic role of resting heart rate (HR) in older compared with younger patients with chronic heart failure (HF).Methods and ResultsIn patients enrolled in the Trial of Intensified Medical Therapy in Elderly Patients With Congestive Heart Failure (TIME-CHF) with sinus rhythm, effects of baseline HR (≥70 vs <70 beats/min [bpm]) on 18-month outcomes were compared between older (≥75 years; n = 186) and younger (<75 years; n = 141) patients. Older patients with lower (61 ± 6 bpm) and higher (83 ± 9 bpm) HR had similar left ventricular ejection fraction (LVEF), New York Heart Association (NYHA) functional class, N-terminal pro–B-type natriuretic peptide (NT-proBNP), and survival and HF hospitalization–free survival. In contrast, younger patients with higher HR (81 ± 7 bpm) had higher NT-proBNP and NYHA functional class, lower LVEF, and a higher risk of death (hazard ratio 4.01 [95% confidence interval (CI) 1.17 −13.69]; P = .02) and death or HF hospitalization (hazard ratio 2.35 [95% CI 1.01–5.50]; P = .04) than those with lower HR (62 ± 5 bpm), with the association between higher HR and survival remaining significant after adjustment for NYHA functional class, LVEF, and NT-proBNP.ConclusionsIn contrast to HF patients aged <75 years, we found no association between HR and worse outcomes in HF patients aged ≥75 years.

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