Preventive cardiology
Relation of heart rate at rest and mortality in the Women's Health and Aging Study

https://doi.org/10.1016/j.amjcard.2003.08.010Get rights and content

Abstract

Increased heart rate (HR) has been shown to be associated with increased risk of all-cause and heart disease mortality. However, HR as a health indicator in disabled older women has not been closely examined. The purpose of this study is to assess the association between HR and 3-year mortality in disabled older women. HR at rest was measured using the electrocardiogram. Three groups were categorized by baseline HR (beats per minute): (1) <60, (2) 60 to 89, and (3) ≥90. The survival rate over 3 years was examined. For the total population, age-adjusted 3-year mortality was nearly 40% for the HR ≥90 group, compared with <20% mortality in the HR 60 to 89 group. Women with a HR <60 beats/min had similar mortality to those with HRs 60 to 89 beats/min. Among women with no heart disease and normal electrocardiograms, mortality was slightly lower in all groups, but the association of elevated HR with increased mortality remained. In Cox proportional hazard models, after adjustment for age, number of diseases, medications, blood pressure, smoking status, body mass index, ankle–brachial index, activity status, physical performance score, and forced expiratory volume in the first second, there remained a twofold increase in the risk of death for the HR ≥90 group. Subclinical conditions not measured in this study, such as mild heart failure, may be associated with both increased HR and mortality; this may explain the relation. In patients with and without heart disease, further investigation of cardiovascular status may be warranted if their HR is ≥90 beats/min.

Section snippets

Study population

The study population is from the Women's Health and Aging Study I (WHAS I), a longitudinal study sponsored by the Laboratory of Epidemiology, Demography, and Biometry of the National Institute on Aging and conducted by The Johns Hopkins Medical Institutions. The WHAS I was designed to identify and study the approximately 1/3 most disabled women living in the community who were aged ≥65 years.

The details of selection criteria and study design have been previously described in detail.4 Briefly, a

Results

Valid electrocardiographic data were available for 953 participants. Patients with pacemakers were excluded. Major electrocardiographic abnormalities (29%, n = 278) were classified as major Q/QS waves (8%), left ventricular hypertrophy (1%), isolated major ST-T-wave abnormality (0.6%), atrial fibrillation or flutter (4%), first-degree atrioventricular block (7%), and ventricular conduction defects (12%). After excluding participants with missing mortality data (n = 11), 942 participants

Discussion

In the total population of women and in women who had no heart disease or electrocardiographic abnormalities, we found that the HR ≥90 group had a twofold increased risk of mortality over the 3-year follow-up period compared with the HR 60 to 89 group when adjusted for age, disease status, cardiovascular risk factors, physical activity, and physical and pulmonary function. The HR <60 group did not show any increased risk of mortality compared with the HR 60 to 89 group.

With multiple competing

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    This study was supported by contract NO1-AG-1-2112 from the National Institute on Aging, National Institutes of Health, Bethesda, Maryland.

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