Dataset Information

Variation in resting heart rate over 4?years and the risks of myocardial infarction and death among older adults.

ABSTRACT: OBJECTIVE:Resting heart rate (RHR) is an established predictor of myocardial infarction (MI) and mortality, but the relationship between variation in RHR over a period of several years and health outcomes is unclear. We evaluated the relationship between long-term variation in RHR and the risks of incident MI and mortality among older adults. METHODS:1991 subjects without cardiovascular disease from the Cardiovascular Health Study were included. RHR was taken from resting ECGs at the first five annual study visits. RHR mean, trend and variation were estimated with linear regression. Subjects were followed for incident MI and death until December 2010. HRs for RHR mean, trend and variation are reported for differences of 10?bpm, 2 bpm/year and 2?bpm, respectively. RESULTS:262 subjects had an incident MI event (13%) and 1326 died (67%) during 12?years of median follow-up. In primary analyses adjusted for cardiovascular risk factors, RHR mean (HR 1.12; 95% CI 1.05 to 1.20) and variation (HR 1.08; 95% CI 1.03 to 1.13) were associated with the risk of death while trend was not. None of the RHR variables were significantly associated with the risk of incident MI events; however, CIs were wide and the MI associations with RHR variables were not significantly different from the mortality associations. Adjusting for additional variables did not affect estimates, and there were no significant interactions with sex. CONCLUSIONS:Variation in RHR over a period of several years represents a potential predictor of long-term mortality among older persons free of cardiovascular disease.

SUBMITTER: Floyd JS

PROVIDER: S-EPMC4286483 | biostudies-literature | 2015 Jan

REPOSITORIES: biostudies-literature

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Variation in resting heart rate over 4 years and the risks of myocardial infarction and death among older adults.

Floyd James S JS Sitlani Colleen M CM Wiggins Kerri L KL Wallace Erin E Suchy-Dicey Astrid A Abbasi Siddique A SA Carnethon Mercedes R MR Siscovick David S DS Sotoodehnia Nona N Heckbert Susan R SR McKnight Barbara B Rice Kenneth M KM Psaty Bruce M BM

Heart (British Cardiac Society) 20140911 2

<h4>Objective</h4>Resting heart rate (RHR) is an established predictor of myocardial infarction (MI) and mortality, but the relationship between variation in RHR over a period of several years and health outcomes is unclear. We evaluated the relationship between long-term variation in RHR and the risks of incident MI and mortality among older adults.<h4>Methods</h4>1991 subjects without cardiovascular disease from the Cardiovascular Health Study were included. RHR was taken from resting ECGs at ...[more]

PMID: 25214500

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Project description:Importance:Although ?-blockers are a mainstay of treatment after acute myocardial infarction (AMI), these medications are commonly not prescribed for older nursing home residents after AMI, in part owing to concerns about potential functional harms and uncertainty of benefit. Objective:To study the association of ?-blockers after AMI with functional decline, mortality, and rehospitalization among long-stay nursing home residents 65 years or older. Design, Setting, and Participants:This cohort study of nursing home residents with AMI from May 1, 2007, to March 31, 2010, used national data from the Minimum Data Set, version 2.0, and Medicare Parts A and D. Individuals with ?-blocker use before AMI were excluded. Propensity score-based methods were used to compare outcomes in people who did vs did not initiate ?-blocker therapy after AMI hospitalization. Main Outcomes and Measures:Functional decline, death, and rehospitalization in the first 90 days after AMI. Functional status was measured using the Morris scale of independence in activities of daily living. Results:The initial cohort of 15?720 patients (11?140 women [70.9%] and 4580 men [29.1%]; mean [SD] age, 83 [8] years) included 8953 new ?-blocker users and 6767 nonusers. The propensity-matched cohort included 5496 new users of ?-blockers and an equal number of nonusers for a total cohort of 10?992 participants (7788 women [70.9%]; 3204 men [29.1%]; mean [SD] age, 84 [8] years). Users of ?-blockers were more likely than nonusers to experience functional decline (odds ratio [OR], 1.14; 95% CI, 1.02-1.28), with a number needed to harm of 52 (95% CI, 32-141). Conversely, ?-blocker users were less likely than nonusers to die (hazard ratio [HR], 0.74; 95% CI, 0.67-0.83) and had similar rates of rehospitalization (HR, 1.06; 95% CI, 0.98-1.14). Nursing home residents with moderate or severe cognitive impairment or severe functional dependency were particularly likely to experience functional decline from ?-blockers (OR, 1.34; 95% CI, 1.11-1.61 and OR, 1.32; 95% CI, 1.10-1.59, respectively). In contrast, little evidence of functional decline due to ?-blockers was found in participants with intact cognition or mild dementia (OR, 1.03; 95% CI, 0.89-1.20; P?=?.03 for effect modification) or in those in the best (OR, 0.99; 95% CI, 0.77-1.26) and intermediate (OR, 1.05; 95% CI, 0.86-1.27) tertiles of functional independence (P?=?.06 for effect modification). Mortality benefits of ?-blockers were similar across all subgroups. Conclusions and Relevance:Use of ?-blockers after AMI is associated with functional decline in older nursing home residents with substantial cognitive or functional impairment, but not in those with relatively preserved mental and functional abilities. Use of ?-blockers yielded a considerable mortality benefit in all groups.

Dataset Information

Variation in resting heart rate over 4?years and the risks of myocardial infarction and death among older adults.

Publications

Variation in resting heart rate over 4 years and the risks of myocardial infarction and death among older adults.

Similar Datasets

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