The following is the summary of “Impact of Heart Rate at Diagnosis on Clinical Outcomes in Patients With Acute Pulmonary Embolism” published in the January 2023 issue of Cardiovascular Disease by Yamashita, et al.

However, there is a lack of information about how patients’ heart rates (HRs) at diagnosis affect clinical outcomes after being diagnosed with acute pulmonary embolism (PE). A total of 1,532 patients were enrolled in this trial, with subgroup analyses based on heart rate (HR): HR 80 beats/min (n=451, 29%), 80 ≤ HR <100 beats/min (n=620, 40%), 100 ≤HR <110 beats/min (n=215, 14%), and HR ≥110 beats/min (n=246, 16%). The cumulative 30-day incidences of all-cause death were significantly higher in the 100 ≤HR <110 and HR ≥110 beats/min groups than in the HR less than 80 beats/min group. For example, incidences were 2.7%, 3.6%, 6.6%, and 5.7% (P=0.04) in the HR less than 80 beats/min, 80 ≤HR <100 beats/min, 100 ≤HR <110 beats/min, and HR ≥110 beats/min groups, respectively. 

With the HR (<80) beats/min group as reference, the 100 ≤HR <110 and HR ≥110 groups, but not the 80 ≤HR <100 groups, were significantly associated with an increased risk of 30-day all-cause death. The hazard ratio was 2.53 (95% CI 1.17 to 5.56, P=0.02) for the 80 ≤HR <100 beats/min group, 2.20 (95% CI 1.02 to 4.84, P=0.046) for the 100 ≤HR <110 beats/min group, and 1.34 (95% CI 0.67 to 2.79, P=0.41) for the HR ≥110 beats/min group. Patients with a simplified Pulmonary Embolism Severity Index score of 0 had a cumulative 30-day all-cause mortality rate of 0.6% when using a cut-off value of HR 110 beats/min, 0.3% when using a cut-off value of HR ≥100 beats/min, and 0.7% when using a cut-off value of HR less than 80 beats/min. 

One possible benefit of the alternative cut-off value of ≤HR <100 beats/min in the simplified Pulmonary Embolism Severity Index score for identification of low-risk patients is that patients with moderate tachycardia (100 HR≥ 110) appeared to be at comparable risk of 30-day all-cause death to those with HR≥110 beats/min and at higher risk than those with HR<80 beats/min.

Source: sciencedirect.com/science/article/abs/pii/S0002914922011353