Prognostic role of minimum heart rate in elderly heart failure patients with hypertensive heart disease: an analysis of MIMIC-IV database

Eur J Med Res. 2025 Apr 17;30(1):303. doi: 10.1186/s40001-025-02574-8.

ABSTRACT

BACKGROUND: Heart rate has been documented as a predictive factor in heart failure. However, its prognostic role in specific heart failure patients is diverse and not comprehensively identified.

METHODS: A retrospective cohort study was conducted based on the MIMIC-IV database. 2476 elderly (≥ 60 years old) patients with heart failure and hypertensive heart disease were recruited. The participants were divided into a low minimum heart rate (MHR) (< 60 bpm) group and a high MHR (≥ 60 bpm) group. Multivariable Cox proportional hazards regression analysis was implemented to evaluate the relationship between the two MHR groups and mortality. The association between prognosis and MHR as a continuous variable was elucidated via the restricted cubic spline model. The association in subgroups was assessed as well.

RESULTS: Compared with high MHR, low MHR was significantly associated with higher 30-day all-cause mortalities (hazard ratio 1.289, 95% confidence interval 1.044 to 1.591, p = 0.018), 90-day all-cause mortality (hazard ratio 1.206, 95% confidence interval 1.007 to 1.444, p = 0.042), and 1-year all-cause mortality (hazard ratio 1.183, 95% confidence interval 1.016 to 1.377, p = 0.03) after adjustment for confounding variables. A U-shaped relationship between outcomes and MHR as a continuous variable was observed, with a nadir at MHR of approximately 50 to 60 bpm. The predictive value of low MHR was significant in women or without comorbidity, but not in men or with comorbidity.

CONCLUSIONS: We demonstrated that MHR plays a prognostic role in elderly patients with heart failure and hypertensive heart disease. Low MHR predicts higher all-cause mortality, and the association conforms to a U-shaped pattern. Our findings extend those of previous studies and suggest the potential predictive value of HR in specific heart failure patients.

PMID:40247409 | PMC:PMC12007124 | DOI:10.1186/s40001-025-02574-8