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Is Age-Predicted Maximal Heart Rate Applicable in Patients With Heart or Lung Disease?
Sang Hun Han1, Min Soo Choi1, Young Mo Kim1
1Department of Rehabilitation Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.
Insights
Predicted maximal heart rate (HRmax) differs significantly from actual HRmax in cardiopulmonary patients, particularly those on beta-blockers or with high BMI. New predictive formulas are proposed for improved accuracy.
Area of Science:
- Cardiology and Exercise Physiology
- Pulmonary Medicine
- Clinical Research
Background:
- Maximal heart rate (HRmax) prediction is crucial for exercise testing and prescription.
- Existing age-predicted HRmax formulas may not accurately reflect individuals with cardiopulmonary diseases.
- Factors like beta-blocker use and body mass index (BMI) can influence HRmax.
Purpose of the Study:
- To compare predicted versus actual HRmax values obtained during cardiopulmonary exercise testing (CPET).
- To identify patient characteristics associated with discrepancies in HRmax prediction.
- To develop improved HRmax estimation formulas for cardiopulmonary patients.
Main Methods:
- Retrospective analysis of 827 patients (age >20) who underwent symptom-limited treadmill CPET.
- Inclusion criteria: ≥85% predicted HRmax (or 62% if on beta-blockers) and respiratory exchange ratio ≥1.1.
- Data collected included diagnosis, beta-blocker use, age, BMI, and CPET parameters; subgroup analyses were performed.
Main Results:
- Significant differences were observed between actual and predicted HRmax (p<0.001).
- Beta-blocker use, high BMI, and moderate-to-high risk classification were associated with significant HRmax differences.
- New formulas proposed: Estimated HRmax = 183 - 0.76 × age (beta-blocker group) and Estimated HRmax = 210 - 0.91 × age (non-beta-blocker group).
Conclusions:
- Age-predicted HRmax significantly underestimates actual HRmax in cardiopulmonary patients, especially those on beta-blockers.
- Actual HRmax is lower than predicted in patients with high BMI and moderate-to-severe risk.
- The proposed formulas may offer more accurate HRmax estimation in this population.
Objective:
To compare the predicted and actual maximal heart rate (HRmax) values in the cardiopulmonary exercise test (CPET).
Methods:
We retrospectively investigated 1,060 patients who underwent a CPET between January 2016 and April 2020 at our institution's cardiopulmonary rehabilitation center. The following patients were included: those aged >20 years, those tested with a treadmill, and those who underwent symptom-limited maximum exercise testing- reaching ≥85% of the predicted HRmax (62% if taking beta-blockers) and highest respiratory exchange ratio ≥1.1. Ultimately, 827 patients were included in this study. Data on diagnosis, history of taking beta-blockers, age, body mass index (BMI), and CPET parameters were collected. Subgroup analysis was performed according to age, betablockers, BMI (low <18.5 kg/m2, normal, and high ≥25 kg/m2), and risk classification.
Results:
There was a significant difference between the actual HRmax and the predicted value (p<0.001). Betablocker administration resulted in a significant difference in the actual HRmax (p<0.001). There were significant differences in the moderate-to-high-risk and low-risk groups and the normal BMI and high BMI groups (p<0.001). There was no significant difference between the elderly and younger groups. We suggest new formulae for HRmax of cardiopulmonary patients: estimated HRmax=183-0.76×age (the beta-blocker group) and etimated HRmax=210-0.91×age (the non-beta-blocker group).
Conclusion:
Age-predicted HRmax was significantly different from the actual HRmax of patients with cardiopulmonary disease, especially in the beta-blocker group. For participants with high BMI and moderate-tosevere risk, the actual HRmax was significantly lower than the predicted HRmax.
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