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Published on: February 14, 2014
Mortality and heart rate in the elderly: role of cognitive impairment
Francesco Cacciatore1, Francesca Mazzella, Pasquale Abete
1Istituto Scientifico di Campoli/Telese, Fondazione Salvatore Maugeri, IRCCS, Benevento, Italy.
Insights
Increased heart rate (HR) predicts mortality in elderly individuals without cognitive impairment (CI). However, HR increase does not appear to be a mortality risk factor in those with CI or the overall elderly population.
Area of Science:
- Gerontology
- Cardiology
- Neurology
Background:
- The relationship between heart rate (HR) and mortality in the elderly, particularly concerning cognitive impairment (CI), is not well-established.
- Understanding factors influencing mortality risk in aging populations is crucial for public health initiatives and clinical practice.
Purpose of the Study:
- To investigate the association between heart rate (HR) increase and mortality in elderly individuals.
- To determine if cognitive impairment (CI) modifies the relationship between HR and mortality.
Main Methods:
- A prospective study followed 1332 randomly selected elderly subjects for 12 years, assessing mortality.
- Subjects were stratified based on the presence or absence of cognitive impairment (CI).
- Heart rate (HR) was analyzed in quartiles, and Cox regression was used for adjusted mortality prediction.
Main Results:
- Mortality showed a linear association with increased HR in the overall group and in those without CI.
- Heart rate (HR) increase was a significant predictor of mortality only in elderly subjects without cognitive impairment (CI).
- No significant association between HR increase and mortality was observed in subjects with CI or in the entire cohort.
Conclusions:
- Heart rate (HR) increase is a significant predictor of mortality in elderly individuals without cognitive impairment (CI).
- Cognitive impairment (CI) appears to negate the predictive value of heart rate (HR) increase on mortality.
- Cognitive status (CI) must be considered when evaluating heart rate (HR) as a potential mortality risk factor in the elderly.
Abstract:
Mortality related to heart rate (HR) increase in the elderly has not yet been well established. To ascertain the relationships among cognitive impairment (CI), mortality, and HR increase, the authors prospectively studied a random sample of elderly subjects stratified according to presence or absence of CI. Elderly subjects randomly selected in 1991 (n = 1332) were followed up for 12 years. Mortality was established in 98.1% of the subjects. When HR was stratified in quartiles (< 69, 70-75, 76-80, and > 80 bpm), mortality was linearly associated with increased HR in all (from 47.7 to 57.0; r2 = .43, p = .019) and in subjects without (from 41.7 to 51.1%; r2 = .50, p = .043) but not in those with CI (from 57.5 to 66.1; r2 = .20, p = .363). Cox regression analysis, adjusted for several variables, shows that HR doesn't predict mortality in all subjects (RR 0.69; 95% CI = 0.27-1.73) or in those with CI (RR 0.91; 95% CI = 0.81-1.02). In contrast, HR predicts mortality in subjects without CI (RR 1.10; 95% CI = 1.00-1.22). Hence, HR increase is a predictor of mortality in elderly subjects without CI. However, when considering all elderly subjects and those with CI, HR increase seems to have no effect on mortality. Thus, CI should be considered when focusing on HR increase as risk factor for mortality in the elderly.
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