Prognostic impact of resting heart rate in patients with peripheral artery disease

Resting heart rate has been increasingly identified as a marker of cardiovascular risk and has been extensively studied as a predictor of coronary artery disease progression. In peripheral artery disease, the prognostic impact of resting heart rate remains elusive.

Consecutive patients undergoing invasive peripheral procedures were included. Data included resting heart rate determination by averaging manual radial pulse palpation measurements taken 24 h before and after an invasive peripheral procedure.

A total of 1720 patients were included (mean age 70±11 years, 38% were female, 39% had critical limb ischemia). During a median follow-up of 729 days, 364 (21.2%) patients died. Resting heart rate emerged as an independent predictor of mortality, even after adjusting for clinical characteristics, peripheral artery disease manifestation and anatomic extent, traditional risk factors, co-morbidities, and disease-modifying therapies: hazard ratio for heart rate >75 bpm was 1.010 (95% confidence interval 1.001-1.109), with each bpm increase in resting heart rate conferring a 1.1% increase in the risk of all-cause mortality (95% confidence interval 0.1-10.9%, adjusted p = 0.030).

Resting heart rate is an independent predictor of mortality in patients with peripheral artery disease; our findings extend heart rate as a possible marker of prognosis to non-coronary atherosclerotic vascular disease.