Dataset Information

Association of heart rate trajectories with the risk of adverse outcomes in a community-based cohort in Taiwan.

ABSTRACT: Heart rate trajectory patterns integrate information regarding multiple heart rate measurements and their changes with time. Different heart rate patterns may exist in one population, and these are associated with different outcomes. Our study investigated the association of adverse outcomes with heart rate trajectory patterns. This was a prospective cohort study based on the Chin-Shan Community Cardiovascular Cohort in Taiwan. A total of 3,015 Chinese community residents aged > 35 years were enrolled in a prospective investigation of cardiovascular risk factors and outcomes from 1990 to 2013.The primary outcome was all-cause mortality, and the secondary outcome was a composite of coronary artery disease and cerebrovascular accidents. The following trajectory patterns were identified: stable, 61%; decreased, 5%; mildly increased, 32%; and markedly increased, 2%. During follow-up (median, 13.9 years), 557 participants died and 217 experienced secondary outcomes. The adjusted hazard ratios of primary and secondary outcomes for participants with a markedly increased trajectory pattern were 1.80 (95% CI [1.18-2.76]) and 1.45 (95% CI [0.67-3.12]), respectively, compared to those for participants with a stable trajectory pattern. A markedly increased heart rate trajectory pattern may be associated with all-cause mortality risks. Heart rate trajectory patterns demonstrated the utility of repeated heart rate measurements for risk assessment.

SUBMITTER: Wei CC

PROVIDER: S-EPMC7211405 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Association of heart rate trajectories with the risk of adverse outcomes in a community-based cohort in Taiwan.

Wei Cheng-Chun CC Chen Pei-Chun PC Hsu Hsiu-Ching HC Su Ta-Chen TC Lin Hung-Ju HJ Chen Ming-Fong MF Lee Yuan-Teh YT Chien Kuo-Liong KL

PeerJ 20200507

Heart rate trajectory patterns integrate information regarding multiple heart rate measurements and their changes with time. Different heart rate patterns may exist in one population, and these are associated with different outcomes. Our study investigated the association of adverse outcomes with heart rate trajectory patterns. This was a prospective cohort study based on the Chin-Shan Community Cardiovascular Cohort in Taiwan. A total of 3,015 Chinese community residents aged > 35 years were en ...[more]

PMID: 32419984

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Project description:Importance:Time-updated heart rate (HR) and temporal change in HR (?HR) are associated with outcome in individuals with established heart failure (HF). Whether these factors are associated with outcomes in a community-based cohort is unclear. Objective:To determine whether the time-updated analysis of resting HR, defined as the most recent HR value measured before occurrence of an event or the end of study, and ?HR over time are associated with outcomes in a community-based cohort. Design, Setting, and Participants:A total of 15?680 participants were enrolled in the Atherosclerosis Risk in Communities cohort study, with HR recorded at baseline and during 3 follow-up visits from 1987 to 1998, with a median interval between visits of 3.0 (interquartile range, 2.9-4.0) years. The ?HR was calculated by assessing a change in HR from the preceding visit. Participants were followed up until December 31, 2014, equating to 28 years of follow-up. The present study was conducted from March 2014 to June 2016 with updated analysis. Main Outcomes and Measures:Baseline HR, time-updated HR, and ?HR associated with outcomes, adjusted for established baseline and time-updated risk factors and medications. The main outcomes measures included all-cause mortality, incident HF, incident myocardial infarction, stroke, and cardiovascular and noncardiovascular death. Results:Of the 15?680 participants, 8656 (55.2%) were women, mean (SD) age was 54 (6) years, and 4218 (26.9%) were African American. Time-updated HR and ?HR were associated with death, incident HF, incident myocardial infarction, stroke, and cardiovascular and noncardiovascular death compared with baseline HR. For example, a ?HR from the preceding visit was significantly associated with increased risk of all-cause mortality (adjusted hazard ratio, 1.12; 95% CI, 1.10-1.15; P?<?.001 for every 5-bpm increase in HR from the preceding visit) and time-updated HR was also significantly associated with increased risk of all-cause mortality (adjusted hazard ratio, 1.14; 95% CI, 1.12-1.17; P?<?.001 for every 5-bpm higher time-updated HR). Conclusions and Relevance:In a community-based cohort, time-updated HR and ?HR are associated with mortality and nonfatal outcomes of incident HF, myocardial infarction, and stroke.

Project description:BACKGROUND:In a real-world setting, the effect of pulse rate measured at the time of diagnosis and serially during follow-up and management, on outcomes in heart failure with reduced ejection fraction (HFrEF), has not been well-studied. Furthermore, how beta-blockade use in a real-world situation modifies this relation between pulse rate and outcomes in HFrEF is not well-known. Hence, we identified a large, national, real-world cohort of HFrEF to examine the association of pulse rate and outcomes. METHODS:Using Veterans Affairs (VA) national electronic health records we identified incident HFrEF cases between 2006 and 2012. We examined the associations of both baseline and serially measured pulse rates, with mortality and days hospitalized per year for heart failure and for any cause, using crude and multivariable Cox proportional hazards and Poisson or negative binomial models, respectively. The exposure was examined as continuous, dichotomous, and categorical. Post-hoc analyses addressed the interaction of pulse rate and beta-blocker target dose. RESULTS:We identified 51,194 incident HFrEF cases (67?±?12?years, 98% male, 77% white. A significant positive, near linear relationship was observed for both baseline and serially measured pulse rates with all-cause mortality, all-cause hospitalization and heart failure hospitalization after adjusting for covariates including beta-blocker use. Patients who had a pulse rate???70?bpm in the past 6?months had 36% (95% CI: 31-42%), 25% (95% CI: 19-32%), and 51% (95% CI: 33-72%) increased rates of mortality, all-cause hospitalization, and heart failure hospitalization, respectively, compared to patients with pulse rates <?70?bpm. A minority of subjects (15%) were treated with guideline directed beta blockade ?50% of recommended target dose, among whom better outcomes were seen compared to those who did not achieve target dose in patients with pulse rates both above and below 70 beats per minute. CONCLUSIONS:High pulse rate, both at the time of diagnosis and during follow-up, is strongly associated with increased risk of adverse outcomes in HFrEF patients, independent of the use of beta-blockers. In a real-world setting, the majority of HFrEF patients do not achieve target dose of beta-blockade; greater use of strategies to reduce heart rate may improve outcomes in HFrEF.

Project description:Objectively measurable biomarkers have not been applied for suicide risk prediction. Resting heart rate (HR) and heart rate variability (HRV) showed potential as trans-diagnostic markers associated with suicide. This study aimed to investigate the associations of resting HR and HRV on proximal suicide risk in patients with diverse psychiatric diagnoses. This chart review study used the medical records of psychiatric patients who visited the outpatient clinic at an academic tertiary hospital. A total of 1,461 patients with diverse psychiatric diagnoses was included in the analysis. Proximal suicide risk was measured using the Mini-International Neuropsychiatric Interview (MINI) suicidal score. Linear regression analyses with the MINI suicidal score as a dependent variable and binary logistic regression analyses with moderate-to-high suicide risk (MINI suicidal risk score ≥6) as a dependent variable were conducted to explore the effects of resting HR and HRV parameters on acute suicide risk after adjusting for age, sex, presence of major depressive disorder (MDD) and bipolar disorder (BD), severity of depression and anxiety severity. We found that 55 (34.6%) patients in the MDD group, 40 (41.7%) in the BD group and 36 (3.9%) in the others group reported moderate-to-high suicide risk. Linear regression analysis revealed that both resting HR and root-mean-square of successive difference (RMSSD) had significant associations with the MINI suicidal score (P = 0.037 with HR, P = 0.003 with RMSSD). In logistic regression, only RMSSD showed a significant association with moderate-to-high suicide risk (P = 0.098 with HR, P = 0.019 with RMSSD), which remained significant in subgroup analysis with patients who reported any suicide-related symptom (MINI suicidal score >0; n = 472; P = 0.017 with HR, P = 0.012 with RMSSD). Our study findings suggest the potential for resting HR and RMSSD as biomarkers for proximal suicide risk prediction. Further research with longitudinal evaluation is needed to confirm our study findings.

Dataset Information

Association of heart rate trajectories with the risk of adverse outcomes in a community-based cohort in Taiwan.

Publications

Association of heart rate trajectories with the risk of adverse outcomes in a community-based cohort in Taiwan.

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