Author + information
- Received August 15, 2016
- Revision received November 7, 2016
- Accepted December 22, 2016
- Published online May 29, 2017.
- Vaiibhav N. Patel, MDa,
- Brian R. Pierce, MDa,
- Rohan K. Bodapati, MDb,
- David L. Brown, MDb,
- Diane G. Ives, MPHc and
- Phyllis K. Stein, PhDb,∗ ()
- aDivision of Hospital Medicine, Washington University School of Medicine, St. Louis, Missouri
- bCardiovascular Division, Washington University School of Medicine, St. Louis, Missouri
- cDepartment of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
- ↵∗Address for correspondence:
Dr. Phyllis K. Stein, Washington University School of Medicine–Cardiovascular Division, 660 South Euclid Avenue, Campus Box 8086, St. Louis, Missouri 63110.
Objectives This study sought to determine whether Holter-based parameters of heart rate variability (HRV) are independently associated with incident heart failure among older adults in the CHS (Cardiovascular Health Study) as evidenced by an improvement in the predictive power of the Health Aging and Body Composition Heart Failure (Health ABC) score.
Background Abnormal HRV, a marker of autonomic dysfunction, has been associated with multiple adverse cardiovascular outcomes but not the development of congestive heart failure (CHF).
Methods Asymptomatic CHS participants with interpretable 24-h baseline Holter recordings were included (n = 1,401). HRV measures and premature ventricular contraction (PVC) counts were compared between participants with (n = 260) and without (n = 1,141) incident CHF on follow-up. Significantly different parameters between groups were added to the components of the Health ABC score, a validated CHF prediction tool, using stepwise Cox regression.
Results The final model included components of the Health ABC score, In PVC counts (adjusted hazard ratio [aHR]: 1.12; 95% confidence interval [CI]: 1.07 to 1.19; p < 0.001) and the following HRV measures: abnormal heart rate turbulence onset (aHR: 1.52; 95% CI: 1.11 to 2.08; p = 0.009), short-term fractal scaling exponent (aHR: 0.27; 95% CI: 0.14 to 0.53; p < 0.001), in very low frequency power (aHR: 1.28; 95% CI: 1.02 to 1.60; p = 0.037), and coefficient of variance of N-N intervals (aHR: 0.94; 95% CI: 0.90 to 0.99; p = 0.009). The C-statistic for the final model was significantly improved over the Health ABC model alone (0.77 vs. 0.73; p = 0.0002).
Conclusions Abnormal HRV parameters were significantly and independently associated with incident CHF in asymptomatic, older adults. When combined with increased PVCs, HRV improved the predictive power of the Health ABC score.
This work was supported in part by National Heart, Lung, and Blood Institute (NHLBI) contracts HHSN268201200036C, HHSN268200800007C, N01HC55222, N01HC85079, N01HC85080, N01HC85081, N01HC85082, N01HC85083, and N01HC85086, and NHLBI grants U01HL080295 and U01HL130114, with additional contribution from the National Institute of Neurological Disorders and Stroke. Additional support was provided through R01AG023629 from the National Institute on Aging. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NHLBI, the National Institutes of Health. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received August 15, 2016.
- Revision received November 7, 2016.
- Accepted December 22, 2016.
- 2017 American College of Cardiology Foundation