Long-term prognostic value of resting heart rate in patients with suspected or proven coronary artery disease

Aims Heart rate reduction is the cornerstone of the treatment of angina. The purpose of this study was to explore the prognostic value of heart rate in patients with stable coronary artery disease (CAD). Methods and results We assessed the relationship between resting heart rate at baseline and cardiovascular mortality/morbidity, while adjusting for risk factors. A total of 24 913 patients with suspected or proven CAD from the Coronary Artery Surgery Study registry were studied for a median follow-up of 14.7 years. All-cause and cardiovascular mortality and cardiovascular rehospitalizations were increased with increasing heart rate (P<0.0001). Patients with resting heart rate ≥83 bpm at baseline had a significantly higher risk for total mortality [hazard ratio (HR)=1.32, CI 1.19–1.47, P<0.0001] and cardiovascular mortality (HR=1.31, CI 1.15–1.48, P<0.0001) after adjustment for multiple clinical variables when compared with the reference group. When comparing patients with heart rates between 77–82 and ≥83 bpm with patients with a heart rate ≤62 bpm, the HR values for time to first cardiovascular rehospitalization were 1.11 and 1.14, respectively (P<0.001 for both). Conclusion Resting heart rate is a simple measurement with prognostic implications. High resting heart rate is a predictor for total and cardiovascular mortality independent of other risk factors in patients with CAD.