Background: In a real-world setting, the effect of pulse rate measured at the time of diagnosis and serially during\nfollow-up and management, on outcomes in heart failure with reduced ejection fraction (HFrEF), has not been wellstudied.\nFurthermore, how beta-blockade use in a real-world situation modifies this relation between pulse rate and\noutcomes in HFrEF is not well-known. Hence, we identified a large, national, real-world cohort of HFrEF to examine\nthe association of pulse rate and outcomes.\nMethods: Using Veterans Affairs (VA) national electronic health records we identified incident HFrEF cases between\n2006 and 2012. We examined the associations of both baseline and serially measured pulse rates, with mortality\nand days hospitalized per year for heart failure and for any cause, using crude and multivariable Cox proportional\nhazards and Poisson or negative binomial models, respectively. The exposure was examined as continuous,\ndichotomous, and categorical. Post-hoc analyses addressed the interaction of pulse rate and beta-blocker target\ndose.......................
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