European Heart Journal Advance Access originally published online on March 17, 2005
European Heart Journal 2005 26(10):967-974; doi:10.1093/eurheartj/ehi190
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Long-term prognostic value of resting heart rate in patients with suspected or proven coronary artery disease
1Department of Medicine, Research Center, Montreal Heart Institute, 5000 Belanger Street E, H1T 1C8 Montreal, Canada
2Montreal Heart Institute Coordinating Center (MHICC), Montreal, Quebec, Canada
Received 22 October 2004; revised 1 February 2005; accepted 3 February 2005; online publish-ahead-of-print 17 March 2005.
* Corresponding author. Tel: +1 514 376 3330; fax: +1 514 593 2500. E-mail address: jean-claude.tardif{at}icm-mhi.org
See page 943 for the editorial comment on this article (doi:10.1093/eurheartj/ehi235)
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.
Key Words: High resting heart rate • Prognosis • Coronary heart disease • Mortality • Cardiovascular mortality • Rehospitalizations
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