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Association of Holter-Derived Heart Rate Variability Parameters With the Development of Congestive Heart Failure in
Vaiibhav N Patel1, Brian R Pierce1, Rohan K Bodapati2
1Division of Hospital Medicine, Washington University School of Medicine, St. Louis, Missouri.
Insights
Heart rate variability (HRV) parameters and premature ventricular contractions (PVCs) independently predict heart failure in older adults. Combining these with the Health ABC score significantly improves heart failure prediction accuracy.
Area of Science:
- Cardiology
- Geriatrics
- Biostatistics
Background:
- Abnormal heart rate variability (HRV), a marker of autonomic dysfunction, is linked to adverse cardiovascular outcomes.
- However, its association with the development of congestive heart failure (CHF) has not been established.
Purpose of the Study:
- To investigate if Holter-based HRV parameters are independently associated with incident heart failure in older adults.
- To assess if these parameters improve the predictive power of the Health Aging and Body Composition (Health ABC) Heart Failure score.
Main Methods:
- 1,401 asymptomatic participants from the Cardiovascular Health Study (CHS) with 24-h Holter recordings were analyzed.
- HRV measures and premature ventricular contraction (PVC) counts were compared between those who developed incident CHF and those who did not.
- Stepwise Cox regression was used to add significant parameters to the Health ABC score.
Main Results:
- Abnormal HRV parameters, including abnormal heart rate turbulence onset and short-term fractal scaling exponent, were significantly associated with incident CHF.
- Increased PVC counts also independently predicted CHF.
- The combined model demonstrated a significant improvement in predictive power (C-statistic 0.77 vs. 0.73).
Conclusions:
- Abnormal HRV parameters and increased PVCs are significant, independent predictors of incident CHF in asymptomatic older adults.
- Incorporating these factors enhances the predictive accuracy of the established Health ABC score for heart failure.
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.