Accelerating Heart Rates Help Certain Heart Failure Patients

Moderately accelerating, personalized pacing enhances heart health compared with the standard care in heart failure with preserved ejection fraction (HFpEF) patients, according to a recent study published in JAMA Cardiology.

Researchers sought to assess the impact of moderately accelerated personalized backup heart rate in comparison with 60 beats per minute (usual care) in patients with stage B and C (HFpEF) with pacemakers. The primary end point was defined as the serial change in Minnesota Living with Heart Failure Questionnaire (MLHFQ) score. The secondary outcomes were stipulated as changes in N-terminal pro–brain natriuretic peptide (NT-proBNP) levels, pacemaker-detected physical activity, atrial fibrillation from baseline, and adverse clinical events. Overall, the analysis consisted of 107 study subjects (median age, 75, 48% female) who were randomized to receive personalized accelerated pacing (n=50) or usual care (n=57).

Over one year of follow up, the results showed that the median (IQR) pacemaker-detected heart rate was 75 (75-80) bpm in the personalized accelerated pacing arm and 65 (63-68) bpm in usual care. The investigators observed that MLHFQ scores improved in the personalized accelerated pacing group (median [IQR] baseline MLHFQ score, 26 [8-45]; at 1 month, 15 [2-25]; at 1 year, 9 [4-21]; P < .001) and worsened with usual care (median [IQR] baseline MLHFQ score, 19 [6-42]; at 1 month, 23 [5-39]; at 1 year, 27 [7-52]; P = .03). Moreover, the researchers noted, personalized accelerated pacing yielded improved changes in NT-proBNP levels (mean [SD] decrease of 109 [498] pg/dL vs increase of 128 [537] pg/dL with usual care; P = .02), activity levels (mean [SD], +47 [67] minutes per day vs −22 [35] minutes per day with usual care; P < .001), and device-detected atrial fibrillation (27% relative risk reduction compared with usual care; P = .04) over 1-year of follow-up.

The researchers concluded that “tailoring the pacemaker backup rate to approximate an individual’s resting heart rate improved outcomes; heart rate modulation, delivered in a way that maintains or optimizes physiologic conduction, may be a therapeutic target in patients with heart failure with preserved ejection fraction.”