Sex-specific longitudinal changes in resting heart rate and all-cause heart failure: insights from the HUNT study

To investigate sex-specific associations between longitudinal resting heart rate (RHR) and new-onset heart failure (HF) using RHR change and RHR trajectories.

Participants from the Trøndelag Health Study attending two or three surveys between 1995 and 2019 were included. We investigated the association between new-onset HF and RHR using RHR categories based on the standard deviation of baseline RHR (12 bpm), continuous RHR modeled using restricted cubic splines (n = 47,712; mean 12-year follow-up), and latent class trajectory models (n = 47,162; mean 7-year follow-up). Cox regression was used to estimate adjusted hazard ratios (HR) and 95% confidence intervals (95% CI).

During follow-up, 2,880 of the 47,712 participants developed HF. The HF incidence rate was lower in women than men (4.27 vs. 5.68 per 1,000 person-years; ratio (95% CI) 0.67 (0.57-0.77). Baseline RHR was 74 bpm in women and 70 bpm in men, and 74% maintained their RHR (±12 bpm) from baseline to the second attendance (mean change -2 ± 12 bpm). Each 10 bpm higher RHR was associated with higher HF risk for both women and men with HRs (95% CI) 1.15 (1.03-1.28) and 1.09 (1.00-1.20), respectively. Participants with a high RHR trajectory had higher HF risk than the low RHR trajectory with HRs (95% CI) 1.43 (1.14-1.79) for women and 1.41 (1.16-1.72) for men.

All-cause HF was similarly associated with increased RHR and a high RHR trajectory for women and men. Estimating HF risk using RHR trajectories provided stronger associations than a single RHR measurement.