Association Between Heart Rate and Mortality in Acute Pulmonary Embolism

In patients with acute pulmonary embolism (PE) who are nonhypotensive, researchers found a positive association between an elevated heart rate (HR) and increased risk for all-cause mortality, as well as PE-related mortality. Results of the analysis were published in the journal Chest.

The analysis used prospectively collected data from patients enrolled in the multicenter, multinational Registro Informatizado de la Enfermedad TromboEmbólica (RIETE), a registry of individuals with acute venous thromboembolism (VTE). The investigators sought to evaluate whether a link exists between baseline HR and PE outcomes across the continuum of HR values. The study included 44,331 consecutive nonhypotensive (ie, systolic blood pressure ≥90 mm Hg) participants from 344 hospitals. All enrollees were from the RIETE registry and had been diagnosed with acute symptomatic PE between January 1, 2001, and February 8, 2021. Study outcomes included 30-day all-cause and PE-specific mortality.

At hospital admission, participants in the high HR groups were more likely to be women than were those in the lower HR groups. Further, participants with high HRs were less likely to have a medical history of VTE, but were more likely to have cancer, recent surgery, immobilization, and chronic lung disease, compared with those with low HRs. The 30-day all-cause mortality was 5.1% (2252 of 44,331 participants); the 30-day PE-related mortality was 1.9% (859 of 44,331 participants).

Results of the study showed that patients in the higher strata of HR levels had significantly higher rates of 30-day all-cause mortality compared with those with HRs in the 80-to-99-beats-per-minute (bpm) range (adjusted odds ratio [aOR], 2.4; 95% CI, 1.9-3.1 for HR ≥140 bpm; aOR, 1.9; 95% CI, 1.6-2.2 for HR 120 to 139 bpm; aOR, 1.7; 95% CI, 1.4-1.9 for HR 110 to 119 bpm; and aOR, 1.5; 95% CI, 1.3 to 1.7 for HR 100 to 109 bpm). Patients in the lower strata of HRs had significantly lower rates of 30-day all-cause mortality compared with those with HRs of 80 to 99 bpm (aOR, 0.6 for HRs of 60 to 79 bpm; aOR, 0.5 for HRs of <60 bpm).

Regarding risk for 30-day PE-related mortality, compared with patients in the 80-to-99-bpm range, patients with HRs of 140 bpm or higher had a 2.4-fold increased risk; patients with HRs 120 to 139 bpm had a 2.2-fold increased risk; patients with HRs 110 to 120 bpm had a1.8-fold increased risk; and patients with HRs 100 to 109 bpm had a 1.7-fold increased risk.

To identify low-risk patients, a cutoff value of 80 bpm, as opposed to 110 bpm, increased the sensitivity of the simplified Pulmonary Embolism Severity Index (sPESI) from 93.4% to 98.8%. To identify intermediate-risk patients, a cutoff value of 140 bpm, as opposed to 110 bpm, increased the specificity of the Bova score from 93.2% to 98.0%.

The researchers concluded that modifying the HR in the sPESI and Bova scores helps to improve the prognostication of patients with PE. This will allow for increased accuracy with respect to clinical decision-making in these individuals.

Disclosure: Some of the study authors have declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 

Reference

Jaureguízar A, Jiménez D, Bikdeli B, et al; RIETE investigators. Heart rate and mortality in patients with acute symptomatic pulmonary embolism.  Chest. Published online August 31, 2021. doi:10.1016/j.chest.2021.08.059