Elevated heart rate increases mortality risk in acute symptomatic pulmonary embolism

A new study in Chest highlights a link between elevated heart rate and risk for all-cause and pulmonary embolism-related mortality in patients with acute symptomatic PE.

“It is unknown if alternative heart rate cutoffs at presentation could capture more accurately the patients at low risk, ideally identifying the best candidates for home therapy and patients at intermediate to high risk, identifying the best candidates for close monitoring or even advanced therapies for PE,” Ana Jaureguízar, MD, with the respiratory department at the Ramón y Cajal Hospital and the CIBER of Respiratory Diseases at the University of Alcalá, Alcalá de Henares, Spain, and colleagues wrote.

The study included 44,331 nonhypotensive patients with symptomatic acute PE at 344 hospitals that participated in the RIETE registry from 2001 to February 2021. Researchers assessed the association between heart rate at hospital admission and all-cause and PE-related mortality.

The primary outcomes were 30-day all-cause and PE-related mortality.

Overall, the rate of 30-day all-cause mortality was 5.1% and 30-day PE-related mortality was 1.9%.

Researchers observed a positive correlation between heart rate at admission and 30-day all-cause and PE-related mortality. Compared with patients with a baseline heart rate of 80 bpm to 99 bpm, the following patients in higher heart rate strata had higher all-cause mortality rates:

• heart rate of 100-109 bpm: adjusted OR = 1.5; 95% CI, 1.3-1.7;
• heart rate of 110-119 bpm: aOR = 1.7; 95% CI, 1.4-1.9;
• heart rate of 120-139 bpm: aOR = 1.9; 95% CI, 1.6-2.2; and
• heart rate of 140 or higher bpm: aOR = 2.4; 95% CI, 1.9-3.1.

In addition, compared with patients with a heart rate of 80 to bpm to 99 bpm, those in the lower strata with a heart rate of 60 bpm to 79 bpm (aOR = 0.64; 95% CI, 0.56-0.74) and less than 60 bpm (aOR = 0.52; 95% CI, 0.35-0.78) had significantly lower 30-day all-cause mortality rates.

Researchers observed similar findings for 30-day PE-related mortality: a 2.4-fold greater risk among those with a heart rate higher than 140 bpm, 2.2-fold greater risk among those with a heart rate of 120 to 139 bpm, 1.8-fold greater risk among those with a heart rate of 110 to 119 bpm and 1.7-fold greater risk among those with a heart rate of 100 to 109 bpm, compared with a heart rate of 80-99 bpm.

A cutoff value of 80 bpm increased the sensitivity of the simplified PE Severity Index from 93.4% to 98.8% for identifying low-risk patients. When identifying intermediate- to high-risk patients, a cutoff value of 140 bpm increased the specificity of the Bova score from 93.2% to 98%.

“Although standard dichotomization of heart rate may be useful for guideline recommendations, our results will allow for more accuracy regarding clinical decision-making,” the researchers wrote.