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Original research
Heart rate: an accessible risk indicator in adult congenital heart disease
  1. Paul M Hendriks1,
  2. Annemien E van den Bosch1,
  3. Jan A Kors2,
  4. Laurie W Geenen1,
  5. Vivan J M Baggen1,
  6. Jannet A Eindhoven1,
  7. Robert M Kauling1,
  8. Judith A A E Cuypers1,
  9. Eric Boersma1,3,
  10. Jolien W Roos-Hesselink1
  1. 1 Department of Cardiology, Erasmus MC, Cardiovascular Institute, Thorax Center, Rotterdam, Netherlands
  2. 2 Department of Medical Informatics, Erasmus MC - University Medical Center Rotterdam, Rotterdam, Netherlands
  3. 3 Department of Clinical Epidemiology, Erasmus MC, Rotterdam, Netherlands
  1. Correspondence to Dr Jolien W Roos-Hesselink, Cardiology, Erasmus MC, Rotterdam, Zuid-Holland, Netherlands; j.roos{at}erasmusmc.nl

Abstract

Background Higher resting heart rate has been described as a risk factor for adverse outcome in healthy individuals and cardiovascular patients. The aim of this study was to evaluate resting heart rate as risk factor in adult congenital heart disease (ACHD).

Methods In this prospective observational cohort study, patients with moderate or complex ACHD were included at routine outpatient visit. Standard 12-lead ECGs were obtained in rest. Heart rate was obtained from the ECG automatically by the Modular ECG Analysis System (MEANS). The primary endpoint was all-cause mortality and the secondary endpoint was a composite of all-cause mortality and heart failure. Survival was derived using the Kaplan-Meier estimator. Subgroups based on heart rate tertiles were compared by the log-rank test. Cox proportional hazards models were adjusted for clinical factors including age, sex and diagnosis (moderate vs complex ACHD).

Results A total of 556 patients were included (median age 32 years (IQR 24–41), 57.6% male). Mean heart rate was 69±13 bpm. Negative chronotropic medication was used by 74 (13.3%) patients. During a median follow-up of 10.1 (IQR 9.6–10.5) years, 36 patients (6.5%) died and 83 (14.9%) reached the secondary endpoint. Patients with higher heart rates had significantly lower survival and heart failure-free survival. After adjusting for clinical factors, heart rate remained associated with mortality (HR 1.57 per 10 bpm, 95% CI 1.26 to 1.96) and mortality or heart failure (HR 1.33 per 10 bpm, 95% CI 1.13 to 1.57).

Conclusion Higher heart rate is associated with lower survival and heart failure-free survival in ACHD.

  • Heart Defects, Congenital
  • Risk Factors
  • Electrocardiography

Data availability statement

The datasets generated and/or analysed during the current study are available from the corresponding author on reasonable request.

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Data availability statement

The datasets generated and/or analysed during the current study are available from the corresponding author on reasonable request.

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Footnotes

  • Contributors Conceptualisation: AEvdB, RMK, JAAEC, EB, JWR-H. Data processing: JAK. Data curation: PMH, LWG, VJMB, JAE. Formal analysis: PMH. Supervision: AEvdB, JWR-H. Writing—original draft: PMH, AEvdB. Writing—review and editing: AEvdB, JAK, LWG, VJMB, JAE, RMK, JAAEC, EB, JWR-H. All authors read and approved the final manuscript. JWR-H takes full responsibility for the integrity of the data and analyses.

  • Funding This work was supported by a grant from the Dutch Heart Foundation, The Hague, the Netherlands (grant number 2015T029) to VJMB.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.