Association of Resting Heart Rate and Temporal Changes in Heart Rate With Outcomes in Participants of the Atherosclerosis Risk in Communities Study

作者：Vazir Ali; Claggett Brian; Cheng Susan; Skali Hicham; Shah Amil; Agulair David; Ballantyne Christie Mitchell; Vardeny Orly; Solomon Scott D^*

来源：JAMA Cardiology, 2018, 3(3): 200-206.

DOI：10.1001/jamacardio.2017.4974

IMPORTANCE Time-updated heart rate (HR) and temporal change in HR (Delta 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 Delta 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 Delta 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 Delta 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 Delta HR were associated with death, incident HF, incidentmyocardial infarction, stroke, and cardiovascular and noncardiovascular death compared with baseline HR. For example, a Delta 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 Delta HR are associated with mortality and nonfatal outcomes of incident HF, myocardial infarction, and stroke.

• 出版日期2018-3