Activated rate-response is associated with increased mortality risk in cardiac device carriers with acute heart failure.

AimsThis 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).MethodsSix 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.ResultsMean 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 pConclusionIn 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

Longitudinal analysis of heart rate from day 1 through day 10 at index hospitalization.

Comparison of daily mean heart rate from day 1 through day 10 during index hospitalization between groups CIED-R (CIED with rate adaptive pacing), CIED-0 (CIED without rate adaptive pacing) and no-CIED (no CIED).</p

Clinical events during hospitalisation and post-discharge by type of cardiac device.

Clinical events during hospitalisation and post-discharge by type of cardiac device.</p

Baseline characteristics by presence of cardiac device and R-mode stimulation.

Baseline characteristics by presence of cardiac device and R-mode stimulation.</p

S1 Graphical abstract -

AimsThis 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).MethodsSix 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.ResultsMean 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 pConclusionIn 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.</div

Mortality risk (Kaplan Meier plot) during the 12-month follow-up period in the CRT subgroup.

Comparison of group CIED-R (CRT with rate-adaptive pacing) to CIED-0 (CRT without rate adaptive pacing). Unadjusted Hazard ratio (HR) with 95% confidence interval (CI) from Cox proportional hazards regression.</p