Heart failure & cardiomyopathiesMeta-analysis
Visit-to-Visit Changes in Heart Rate in Heart Failure: A Pooled Participant-Level Analysis of the PARADIGM-HF and PARAGON-HF Trials
- Pooled participant-level analysis of the PARADIGM-HF and PARAGON-HF randomised trials
- covariate-adjusted Cox proportional hazards models
Authors' conclusion
Across a broad spectrum of patients with chronic HF, increases in HR from a preceding visit independently predicted clinical outcomes.
Study context
- Population
- Patients with heart failure (HF) across the full range of left ventricular ejection fraction (LVEF) (LVEF ≤40% in PARADIGM-HF, ≥45% in PARAGON-HF)
- Participants
- 13,194 patients
- Comparison
- Visit-to-visit HR increase or drop vs no change
- Outcome
- HF hospitalization or CV death
- Follow-up
- Median 2.5 years
Pooled result
As reported in the abstract
Each group vs no changeHazard ratio (95% CI)P value
Increase in HRper 5 bpm increase
1.12(1.10–1.15)
P < 0.001Drop in HRper 5 bpm drop
0.97(0.94–1.00)
P = 0.044- First HF hospitalization or CV death events
- 3114 (10.4 events per 100 patient-years)
Further pooled results
Prognostic implications of ΔHR by LVEF, β-blocker use, permanent pacemaker (subgroups)
- Consistent across the range of LVEF and regardless of β-blocker use or permanent pacemaker
HR increase, by AF (subgroup)
- Increases in HR especially prognostic in patients without AF
- interaction P = 0.006
Original publication
Visit-to-Visit Changes in Heart Rate in Heart Failure: A Pooled Participant-Level Analysis of the PARADIGM-HF and PARAGON-HF Trials. Eur J Heart Fail. Published 22 October 2024. doi:10.1002/ejhf.3487
Summarised from the published abstract; every number is checked against it