Increased heart rate on first day in Intensive Care Unit is associated with increased mortality

Area of Science:

• Critical Care Medicine
• Cardiovascular Physiology
• Clinical Outcomes Research

Background:

• Patient monitoring in intensive care units (ICUs) is crucial for predicting outcomes.
• Heart rate (HR) is a vital sign that can reflect a patient's physiological status.
• Identifying early predictors of mortality can aid in timely clinical interventions.

Purpose of the Study:

• To examine the association between maximum heart rate (HR) on the first day of intensive care unit (ICU) admission and patient mortality.
• To determine if a maximum HR threshold can serve as a predictor of mortality in critically ill patients.

Main Methods:

• Retrospective analysis of data from 850 patients aged over 45 admitted to the ICU.
• Patients were categorized into two groups based on maximum HR on day one: Group-I (HR < 100/min) and Group-II (HR ≥ 100/min).
• Comparison of demographic data, comorbidities, treatments, physiological parameters, and mortality rates between the two groups, including analysis of CHARLSON and APACHE-II scores.

Main Results:

• Group-II patients (max HR ≥ 100/min) exhibited significantly higher rates of vasopressor and inotropic drug use, anemia, and mechanical ventilation compared to Group-I (max HR < 100/min).
• Higher CHARLSON and APACHE-II scores, longer ICU and hospital stays, and increased ICU and hospital mortality were observed in Group-II.
• Multivariate logistic regression identified APACHE-II scores and a maximum HR < 100/min as independent predictors of ICU mortality, while beta-blocker use was not a significant predictor.

Conclusions:

• A maximum heart rate below 100 beats per minute on the first day of ICU admission is associated with reduced mortality.
• This finding suggests that maintaining a lower maximum HR in the initial phase of critical illness may indicate a more favorable prognosis.