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Low heart rate at follow up predicts improvement of ejection fraction in a large-volume cohort of women with wearable cardioverter defibrillator

Session Poster Session 1

Speaker Lore Schrutka

Congress : Heart Failure 2019

  • Topic : arrhythmias and device therapy
  • Sub-topic : Implantable Cardioverter / Defibrillator
  • Session type : Poster Session
  • FP Number : P242

Authors : L Schrutka (Vienna,AT), J W Erath (Frankfurt am Main,DE), V Kutiyfa (Rochester,US), B Assmus (Giessen,DE), A Burch (Greenville,US), A M Russo (Camden,US), D Bonderman (Vienna,AT)

Authors:
L Schrutka1 , J W Erath2 , V Kutiyfa3 , B Assmus4 , A Burch5 , A M Russo6 , D Bonderman1 , 1Medical University of Vienna, Cardiology - Vienna - Austria , 2JW Goethe University, Department of Cardiology - Frankfurt am Main - Germany , 3University of Rochester - Rochester - United States of America , 4University of Giessen - Giessen - Germany , 5Department of Cardiovascular Sciences, East Carolina University - Greenville - United States of America , 6Cooper University Hospital - Camden - United States of America ,

Citation:

Background. Wearable cardioverter defibrillators (WCD) are effective in short-term therapy of ventricular arrhythmias and serve as diagnostic tools with continuous heart rate (HR) monitoring. Previous studies highlighted the importance of HR control in heart failure. Women at risk for sudden cardiac death are not well studied. The objective was to evaluate the impact of HR on improvement of ejection fraction (EF) in women provided with WCDs.

Methods. Data from women fitted with WCD from 2015 to 2018 were obtained from the manufacturer’s database. Quartiles of HR were compared between patients showing improvement of EF and patients who either had indication for implantable cardioverter defibrillators (ICD) or died.

Results. A total of 15 321 women with mean age of 66 ± 13 years were included. Mean time of WCD use was 96 ± 50 days. Patients with improvement of EF had significantly lower HR compared to patients who died or received an ICD. Univariable logistic regression showed that lower HR was predictive for improvement, with nighttime HR at follow up showing strongest predictive power with OR of 2.06 (95%CI 1.90-2.23, p<0.001). Multivariable adjustment revealed that daytime, nighttime and delta nighttime HR at the end of WCD use was predictive for improvement.

Conclusion. HR was significantly lower in patients showing improvement of EF. Absolute daytime, nighttime and delta nighttime HR at follow up showed predictive ability for recovery.

Variable

Quartile 1

Odds ratio

95% Confidence interval

P value

Adjusted Odds

ratio

95% Confidence interval

P value

Daytime HR at baseline, bpm

Ref Quartile 4: HR>87

70

1.53

(1.41-1.65)

<0.001

1.11

(0.93-1.33)

0.263

Daytime HR at follow up, bpm

Ref Quartile 4: HR>84

67

1.99

(1.84-2.15)

<0.001

1.32

(1.11-1.56)

0.001

Daytime delta HR, bpm

Ref Quartile 4:delta HR >8.72

≤2.29

0.77

(0.71-0.83)

<0.001

1.02

(0.87-1.18)

0.846

Nighttime HR at baseline, bpm

Ref Quartile 4: HR>84

67

1.53

(1.42-1.65)

<0.001

1.12

(0.93-1.34)

0.227

Nighttime HR at follow up, bpm

Ref Quartile 4: HR>82

≤ 65

2.06

(1.90-2.23)

<0.001

1.36

(1.15-1.61)

<0.001

Nighttime delta HR, bpm

Ref Quartile 4: HR>9.51

-1.36

0.72

(0.67-0.78)

<0.001

0.78

(0.67-0.91)

0.001

EF, ejection fraction; ICD, implantable cardioverter defibrillator; bpm, beats per minute; WCD, wearable cardioverter defibrillator Delta indicates the difference between HR at baseline and follow up.

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