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Heart failure and cardiomyopathies
Original article
Ambulatory heart rate range predicts mode-specific mortality and hospitalisation in chronic heart failure
  1. Richard M Cubbon1,
  2. Naomi Ruff1,
  3. David Groves2,3,
  4. Antonio Eleuteri2,3,
  5. Christine Denby2,3,
  6. Lorraine Kearney1,
  7. Noman Ali1,
  8. Andrew M N Walker1,
  9. Haqeel Jamil1,
  10. John Gierula1,
  11. Chris P Gale1,
  12. Phillip D Batin4,
  13. James Nolan5,
  14. Ajay M Shah6,
  15. Keith A A Fox7,
  16. Robert J Sapsford8,
  17. Klaus K Witte1,
  18. Mark T Kearney1
  1. 1Multidisciplinary Cardiovascular Research Centre, LIGHT Laboratories, The University of Leeds, Leeds, UK
  2. 2Medical Physics and Clinical Engineering Department, Royal Liverpool University Hospital, Liverpool, UK
  3. 3Physics Department, University of Liverpool, Liverpool, UK
  4. 4Cardiology Department, Pinderfields General Hospital, Mid Yorkshire Hospitals NHS Trust, Wakefield, UK
  5. 5University Hospital of North Staffordshire, Stoke-on-Trent, UK
  6. 6BHF Centre of Excellence, King's College London, London, UK
  7. 7BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
  8. 8Cardiology Department, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
  1. Correspondence to Dr Richard M Cubbon, Multidisciplinary Cardiovascular Research Centre, LIGHT Laboratories, The University of Leeds, Clarendon Way, Leeds LS2 9JT, UK; R.Cubbon{at}Leeds.ac.uk

Abstract

Objective We aimed to define the prognostic value of the heart rate range during a 24 h period in patients with chronic heart failure (CHF).

Methods Prospective observational cohort study of 791 patients with CHF associated with left ventricular systolic dysfunction. Mode-specific mortality and hospitalisation were linked with ambulatory heart rate range (AHRR; calculated as maximum minus minimum heart rate using 24 h Holter monitor data, including paced and non-sinus complexes) in univariate and multivariate analyses. Findings were then corroborated in a validation cohort of 408 patients with CHF with preserved or reduced left ventricular ejection fraction.

Results After a mean 4.1 years of follow-up, increasing AHRR was associated with reduced risk of all-cause, sudden, non-cardiovascular and progressive heart failure death in univariate analyses. After accounting for characteristics that differed between groups above and below median AHRR using multivariate analysis, AHRR remained strongly associated with all-cause mortality (HR 0.991/bpm increase in AHRR (95% CI 0.999 to 0.982); p=0.046). AHRR was not associated with the risk of any non-elective hospitalisation, but was associated with heart-failure-related hospitalisation. AHRR was modestly associated with the SD of normal-to-normal beats (R2=0.2; p<0.001) and with peak exercise-test heart rate (R2=0.33; p<0.001). Analysis of the validation cohort revealed AHRR to be associated with all-cause and mode-specific death as described in the derivation cohort.

Conclusions AHRR is a novel and readily available prognosticator in patients with CHF, which may reflect autonomic tone and exercise capacity.

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

https://doi.org/10.1136/heartjnl-2015-308428

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