Effect of Heart Rate and Use of Beta Blockers on Mortality After Heart Transplantation.

Abstract

Heart transplantation (HT) recipients may have tachycardia secondary to cardiac denervation. As higher heart rate predicts worse outcomes in cardiovascular disease, we hypothesized that tachycardia and nonuse of β blockers are associated with increased mortality after HT. All patients who underwent HT at our institution from 1987 to 2010 were included. The association of heart rate 3 months after HT and β-blocker use during follow-up to mortality was assessed using Kaplan-Meier and multivariate Cox proportional hazards regression analyses adjusting for clinically relevant baseline variables. From 1987 to 2010, there were 493 HT. After excluding 29 who died within 3 months and 3 with follow-up <3 months, 461 HT recipients (50 ± 2 years; 20% women) were included. Over a follow-up of 12 ± 7 years, selected important univariate predictors of post-HT mortality were older age, male gender, higher body mass index, ischemic cardiomyopathy, longer post-HT intensive care unit stay, and hospitalization and at 3 months, increased mean pulmonary artery pressure, right atrial pressure and pulmonary capillary occlusion pressure, higher heart rate, and nonuse of β blockers during follow-up. In multivariate analysis, older ager, longer hospitalization, higher mean pulmonary artery pressure, higher heart rate at 3 months (hazard ratio 1.02 per beat, 95% confidence interval 1.008 to 1.035, p = 0.02) and nonuse of β blockers (hazard ratio 1.43, 95% confidence interval 1.002 to 2.031, p <0.05) were associated with mortality. In conclusion, in a large single-center cohort of HT recipients, higher heart rate and nonuse of β blockers were independently associated with higher mortality.

• Authors: Agnieszka Ciarka, Lars H Lund, Johan Van Cleemput, Gabor Voros, Walter Droogne, Johan Vanhaecke
• Journal: The American journal of cardiology (Am J Cardiol) Vol. 118 Issue 12 Pg. 1916-1921 (Dec 15 2016) ISSN: 1879-1913 [Electronic] United States
• PMID: 27743576 (Publication Type: Journal Article, Observational Study)
• Copyright: Copyright © 2016 Elsevier Inc. All rights reserved.

Chemical References

• Adrenergic beta-Antagonists

Topics

• Adrenergic beta-Antagonists (therapeutic use)
• Adult
• Age Factors
• Blood Preservation
• Cardiomyopathy, Dilated (surgery)
• Cohort Studies
• Female
• Heart Rate
• Heart Transplantation
• Humans
• Intensive Care Units
• Kaplan-Meier Estimate
• Length of Stay
• Male
• Middle Aged
• Mortality
• Multivariate Analysis
• Myocardial Ischemia (epidemiology, surgery)
• Proportional Hazards Models
• Protective Factors
• Pulmonary Wedge Pressure
• Retrospective Studies
• Sex Factors
• Treatment Outcome