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Huttelmaier MT, Münsterer S, Morbach C, Sahiti F, Scholz N, Albert J, Gabel A, Angermann C, Ertl G, Frantz S, Störk S, Fischer TH. Activated rate-response is associated with increased mortality risk in cardiac device carriers with acute heart failure. PLoS One 2024; 19:e0302321. [PMID: 38635729 PMCID: PMC11025974 DOI: 10.1371/journal.pone.0302321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 04/01/2024] [Indexed: 04/20/2024] Open
Abstract
AIMS This study investigated whether an activated R-mode in patients carrying a cardiac implantable electronic device (CIED) is associated with worse prognosis during and after an episode of acutely decompensated heart failure (AHF). METHODS Six hundred and twenty-three patients participating in an ongoing prospective cohort study that phenotypes and follows patients admitted for AHF were studied. We compared CIED carriers with activated R-mode stimulation (CIED-R) to CIED carriers not in R-mode (CIED-0) and patients without CIEDs (no-CIED). The independent impact of R-mode activation on 12-month all-cause death was examined using uni- and multivariable Cox proportional hazards regression taking into account potential confounders, and hazard ratios (HR) with their 95% confidence intervals (CI) were reported. RESULTS Mean heart rate on admission was lower in CIED-R (n = 37, 16% women) vs. CIED-0 (n = 64, 23% women) or no-CIED (n = 511, 43% women): 70 bpm vs. 80 bpm or 82 bpm; both p<0.001. In-hospital mortality was similar across groups, but age- and sex-adjusted all-cause 12-month mortality risk was differentially affected by R-mode activation; CIED-R vs. CIED-0: HR 2.44, 95%CI 1.25-4.74; CIED-R vs. no-CIED: HR 2.61, 95%CI 1.59-4.29. These effects persisted after multivariable adjustment for potential confounders. Within CIED-R, mortality risk was similar in patients with pacemakers vs. ICDs and in subgroups with left ventricular ejection fraction (LVEF) <50% vs. ≥50%. CONCLUSION In patients admitted with AHF, R-mode stimulation was associated with a significantly increased 12-month mortality risk. Our findings shed new light on "admission heart rate" as a potentially treatable target in AHF. Our data are compatible with the concept that chronotropic incompetence contributes to an adverse outcome in these patients and may not be adequately treated through accelerometer-based R-mode stimulation.
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Affiliation(s)
| | - Sascha Münsterer
- Dept. of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
- Dept. Clinical Research & Epidemiology, Comprehensive Heart Failure Centre Würzburg, Würzburg, Germany
| | - Caroline Morbach
- Dept. of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
- Dept. Clinical Research & Epidemiology, Comprehensive Heart Failure Centre Würzburg, Würzburg, Germany
| | - Floran Sahiti
- Dept. of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
- Dept. Clinical Research & Epidemiology, Comprehensive Heart Failure Centre Würzburg, Würzburg, Germany
| | - Nina Scholz
- Dept. Clinical Research & Epidemiology, Comprehensive Heart Failure Centre Würzburg, Würzburg, Germany
| | - Judith Albert
- Dept. of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
- Dept. Clinical Research & Epidemiology, Comprehensive Heart Failure Centre Würzburg, Würzburg, Germany
| | - Alexander Gabel
- Helmholtz Institute for RNA-based Infection Research (HIRI), Helmholtz Centre for Infection Research (HZI), Würzburg, Germany
- Infection Control and Antimicrobial Stewardship Unit, University Hospital Würzburg, Würzburg, Germany
| | - Christiane Angermann
- Dept. Clinical Research & Epidemiology, Comprehensive Heart Failure Centre Würzburg, Würzburg, Germany
| | - Georg Ertl
- Dept. Clinical Research & Epidemiology, Comprehensive Heart Failure Centre Würzburg, Würzburg, Germany
| | - Stefan Frantz
- Dept. of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
- Dept. Clinical Research & Epidemiology, Comprehensive Heart Failure Centre Würzburg, Würzburg, Germany
| | - Stefan Störk
- Dept. of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
- Dept. Clinical Research & Epidemiology, Comprehensive Heart Failure Centre Würzburg, Würzburg, Germany
| | - Thomas H. Fischer
- Dept. of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
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