Ambulatory heart rate range predicts mode-specific mortality and hospitalisation in chronic heart failure

Richard M Cubbon; Naomi Ruff; David Groves; Antonio Eleuteri; Christine Denby; Lorraine Kearney; Noman Ali; Andrew M N Walker; Haqeel Jamil; John Gierula; Chris P Gale; Phillip D Batin; James Nolan; Ajay M Shah; Keith A A Fox; Robert J Sapsford; Klaus K Witte; Mark T Kearney

doi:10.1136/heartjnl-2015-308428

Ambulatory heart rate range predicts mode-specific mortality and hospitalisation in chronic heart failure

Richard M Cubbon, Naomi Ruff, David Groves, Antonio Eleuteri, Christine Denby, Lorraine Kearney, Noman Ali, Andrew M N Walker, Haqeel Jamil, John Gierula, Chris P Gale, Phillip D Batin, James Nolan, Ajay M Shah, Keith A A Fox, Robert J Sapsford, Klaus K Witte, Mark T Kearney

Research output: Contribution to journal › Article › peer-review

Abstract / Description of output

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 (R(2)=0.2; p<0.001) and with peak exercise-test heart rate (R(2)=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.

Original language	English
Pages (from-to)	223-9
Number of pages	7
Journal	Heart
Volume	102
Issue number	3
Early online date	16 Dec 2015
DOIs	https://doi.org/10.1136/heartjnl-2015-308428
Publication status	Published - 1 Feb 2016

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10.1136/heartjnl-2015-308428

Fox K Ambulatory heart rate range...
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Cubbon, R. M., Ruff, N., Groves, D., Eleuteri, A., Denby, C., Kearney, L., Ali, N., Walker, A. M. N., Jamil, H., Gierula, J., Gale, C. P., Batin, P. D., Nolan, J., Shah, A. M., Fox, K. A. A., Sapsford, R. J., Witte, K. K., & Kearney, M. T. (2016). Ambulatory heart rate range predicts mode-specific mortality and hospitalisation in chronic heart failure. Heart, 102(3), 223-9. https://doi.org/10.1136/heartjnl-2015-308428

@article{df961e9eebf64333880629cdf23e02ed,

title = "Ambulatory heart rate range predicts mode-specific mortality and hospitalisation in chronic heart failure",

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 (R(2)=0.2; p<0.001) and with peak exercise-test heart rate (R(2)=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.",

author = "Cubbon, {Richard M} and Naomi Ruff and David Groves and Antonio Eleuteri and Christine Denby and Lorraine Kearney and Noman Ali and Walker, {Andrew M N} and Haqeel Jamil and John Gierula and Gale, {Chris P} and Batin, {Phillip D} and James Nolan and Shah, {Ajay M} and Fox, {Keith A A} and Sapsford, {Robert J} and Witte, {Klaus K} and Kearney, {Mark T}",

note = "Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/",

year = "2016",

month = feb,

day = "1",

doi = "10.1136/heartjnl-2015-308428",

language = "English",

volume = "102",

pages = "223--9",

journal = "Heart",

issn = "1355-6037",

publisher = "BMJ Publishing Group",

number = "3",

}

Cubbon, RM, Ruff, N, Groves, D, Eleuteri, A, Denby, C, Kearney, L, Ali, N, Walker, AMN, Jamil, H, Gierula, J, Gale, CP, Batin, PD, Nolan, J, Shah, AM, Fox, KAA, Sapsford, RJ, Witte, KK & Kearney, MT 2016, 'Ambulatory heart rate range predicts mode-specific mortality and hospitalisation in chronic heart failure', Heart, vol. 102, no. 3, pp. 223-9. https://doi.org/10.1136/heartjnl-2015-308428

TY - JOUR

T1 - Ambulatory heart rate range predicts mode-specific mortality and hospitalisation in chronic heart failure

AU - Cubbon, Richard M

AU - Ruff, Naomi

AU - Groves, David

AU - Eleuteri, Antonio

AU - Denby, Christine

AU - Kearney, Lorraine

AU - Ali, Noman

AU - Walker, Andrew M N

AU - Jamil, Haqeel

AU - Gierula, John

AU - Gale, Chris P

AU - Batin, Phillip D

AU - Nolan, James

AU - Shah, Ajay M

AU - Fox, Keith A A

AU - Sapsford, Robert J

AU - Witte, Klaus K

AU - Kearney, Mark T

N1 - Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

PY - 2016/2/1

Y1 - 2016/2/1

N2 - 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 (R(2)=0.2; p<0.001) and with peak exercise-test heart rate (R(2)=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.

AB - 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 (R(2)=0.2; p<0.001) and with peak exercise-test heart rate (R(2)=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.

U2 - 10.1136/heartjnl-2015-308428

DO - 10.1136/heartjnl-2015-308428

M3 - Article

C2 - 26674986

SN - 1355-6037

VL - 102

SP - 223

EP - 229

JO - Heart

JF - Heart

IS - 3

ER -

Ambulatory heart rate range predicts mode-specific mortality and hospitalisation in chronic heart failure

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