Is the Median Hourly Ambulatory Heart Rate Range Helpful in Stratifying Mortality Risk among Newly Diagnosed Atrial Fibrillation Patients?

Is the Median Hourly Ambulatory Heart Rate Range Helpful in Stratifying Mortality Risk among Newly Diagnosed Atrial Fibrillation Patients?

<b>Background:</b> The application of heart rate variability is problematic in patients with atrial fibrillation (AF). This study aims to explore the associations between all-cause mortality and the median hourly ambulatory heart rate range (<inline-formula><math xmlns="htt...

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Autores principales: Hsing-Yu Chen, John Malik, Hau-Tieng Wu, Chun-Li Wang
Formato: article
Lenguaje:EN
Publicado: MDPI AG 2021
Materias:
all-cause mortality
atrial fibrillation
Holter monitor
the median hourly ambulatory heart rate range
Medicine
R
Acceso en línea:https://doaj.org/article/e156f099e7934e1399c547e0f79a76d4
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id oai:doaj.org-article:e156f099e7934e1399c547e0f79a76d4
record_format dspace
institution DOAJ
collection DOAJ
language EN
topic all-cause mortality
atrial fibrillation
Holter monitor
the median hourly ambulatory heart rate range
Medicine
R
spellingShingle all-cause mortality
atrial fibrillation
Holter monitor
the median hourly ambulatory heart rate range
Medicine
R
Hsing-Yu Chen
John Malik
Hau-Tieng Wu
Chun-Li Wang
Is the Median Hourly Ambulatory Heart Rate Range Helpful in Stratifying Mortality Risk among Newly Diagnosed Atrial Fibrillation Patients?
description <b>Background:</b> The application of heart rate variability is problematic in patients with atrial fibrillation (AF). This study aims to explore the associations between all-cause mortality and the median hourly ambulatory heart rate range (<inline-formula><math xmlns="http://www.w3.org/1998/Math/MathML" display="inline"><semantics><mrow><msub><mrow><mover accent="true"><mrow><mi>A</mi><mi>H</mi><mi>R</mi><mi>R</mi></mrow><mo stretchy="true">˜</mo></mover></mrow><mrow><mn>24</mn><mi>h</mi><mi>r</mi></mrow></msub></mrow></semantics></math></inline-formula>) compared with other parameters obtained from the Holter monitor in patients with newly diagnosed AF. <b>Material and Methods:</b> A total of 30 parameters obtained from 521 persistent AF patients’ Holter monitor were analyzed retrospectively from 1 January 2010 to 31 July 2014. Every patient was followed up to the occurrence of death or the end of 30 June 2017. <b>Results:</b><inline-formula><math xmlns="http://www.w3.org/1998/Math/MathML" display="inline"><semantics><mrow><msub><mrow><mover accent="true"><mrow><mi>A</mi><mi>H</mi><mi>R</mi><mi>R</mi></mrow><mo stretchy="true">˜</mo></mover></mrow><mrow><mn>24</mn><mi>h</mi><mi>r</mi></mrow></msub></mrow></semantics></math></inline-formula> was the most feasible Holter parameter. Lower <inline-formula><math xmlns="http://www.w3.org/1998/Math/MathML" display="inline"><semantics><mrow><msub><mrow><mover accent="true"><mrow><mi>A</mi><mi>H</mi><mi>R</mi><mi>R</mi></mrow><mo stretchy="true">˜</mo></mover></mrow><mrow><mn>24</mn><mi>h</mi><mi>r</mi></mrow></msub></mrow></semantics></math></inline-formula> was associated with increased risk of all-cause mortality (adjusted hazard ratio [aHR] for every 10-bpm reduction: 2.70, 95% confidence interval [CI]: 1.75–4.17, <i>p</i> < 0.001). The C-statistic of <inline-formula><math xmlns="http://www.w3.org/1998/Math/MathML" display="inline"><semantics><mrow><msub><mrow><mover accent="true"><mrow><mi>A</mi><mi>H</mi><mi>R</mi><mi>R</mi></mrow><mo stretchy="true">˜</mo></mover></mrow><mrow><mn>24</mn><mi>h</mi><mi>r</mi></mrow></msub></mrow></semantics></math></inline-formula> alone was 0.707 (95% CI: 0.658–0.756), and 0.697 (95% CI: 0.650–0.744) for the CHA2DS2-VASc score alone. By combining <inline-formula><math xmlns="http://www.w3.org/1998/Math/MathML" display="inline"><semantics><mrow><msub><mrow><mover accent="true"><mrow><mi>A</mi><mi>H</mi><mi>R</mi><mi>R</mi></mrow><mo stretchy="true">˜</mo></mover></mrow><mrow><mn>24</mn><mi>h</mi><mi>r</mi></mrow></msub></mrow></semantics></math></inline-formula> with the CHA2DS2-VASc score, the C-statistic could improve to 0.764 (95% CI: 0.722–0.806). While using 20 bpm as the cut-off value, the aHR was 3.66 (95% CI: 2.05–6.52) for patients with <inline-formula><math xmlns="http://www.w3.org/1998/Math/MathML" display="inline"><semantics><mrow><msub><mrow><mover accent="true"><mrow><mi>A</mi><mi>H</mi><mi>R</mi><mi>R</mi></mrow><mo stretchy="true">˜</mo></mover></mrow><mrow><mn>24</mn><mi>h</mi><mi>r</mi></mrow></msub></mrow></semantics></math></inline-formula> < 20 bpm in contrast to patients with <inline-formula><math xmlns="http://www.w3.org/1998/Math/MathML" display="inline"><semantics><mrow><msub><mrow><mover accent="true"><mrow><mi>A</mi><mi>H</mi><mi>R</mi><mi>R</mi></mrow><mo stretchy="true">˜</mo></mover></mrow><mrow><mn>24</mn><mi>h</mi><mi>r</mi></mrow></msub></mrow></semantics></math></inline-formula> ≥ 20 bpm. <b>Conclusions:</b><inline-formula><math xmlns="http://www.w3.org/1998/Math/MathML" display="inline"><semantics><mrow><msub><mrow><mover accent="true"><mrow><mi>A</mi><mi>H</mi><mi>R</mi><mi>R</mi></mrow><mo stretchy="true">˜</mo></mover></mrow><mrow><mn>24</mn><mi>h</mi><mi>r</mi></mrow></msub></mrow></semantics></math></inline-formula> could be helpful for risk stratification for AF in addition to the CHA2DS2-VASc score.
format article
author Hsing-Yu Chen
John Malik
Hau-Tieng Wu
Chun-Li Wang
author_facet Hsing-Yu Chen
John Malik
Hau-Tieng Wu
Chun-Li Wang
author_sort Hsing-Yu Chen
title Is the Median Hourly Ambulatory Heart Rate Range Helpful in Stratifying Mortality Risk among Newly Diagnosed Atrial Fibrillation Patients?
title_short Is the Median Hourly Ambulatory Heart Rate Range Helpful in Stratifying Mortality Risk among Newly Diagnosed Atrial Fibrillation Patients?
title_full Is the Median Hourly Ambulatory Heart Rate Range Helpful in Stratifying Mortality Risk among Newly Diagnosed Atrial Fibrillation Patients?
title_fullStr Is the Median Hourly Ambulatory Heart Rate Range Helpful in Stratifying Mortality Risk among Newly Diagnosed Atrial Fibrillation Patients?
title_full_unstemmed Is the Median Hourly Ambulatory Heart Rate Range Helpful in Stratifying Mortality Risk among Newly Diagnosed Atrial Fibrillation Patients?
title_sort is the median hourly ambulatory heart rate range helpful in stratifying mortality risk among newly diagnosed atrial fibrillation patients?
publisher MDPI AG
publishDate 2021
url https://doaj.org/article/e156f099e7934e1399c547e0f79a76d4
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AT hautiengwu isthemedianhourlyambulatoryheartraterangehelpfulinstratifyingmortalityriskamongnewlydiagnosedatrialfibrillationpatients
AT chunliwang isthemedianhourlyambulatoryheartraterangehelpfulinstratifyingmortalityriskamongnewlydiagnosedatrialfibrillationpatients
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spelling oai:doaj.org-article:e156f099e7934e1399c547e0f79a76d42021-11-25T18:07:58ZIs the Median Hourly Ambulatory Heart Rate Range Helpful in Stratifying Mortality Risk among Newly Diagnosed Atrial Fibrillation Patients?10.3390/jpm111112022075-4426https://doaj.org/article/e156f099e7934e1399c547e0f79a76d42021-11-01T00:00:00Zhttps://www.mdpi.com/2075-4426/11/11/1202https://doaj.org/toc/2075-4426<b>Background:</b> The application of heart rate variability is problematic in patients with atrial fibrillation (AF). This study aims to explore the associations between all-cause mortality and the median hourly ambulatory heart rate range (<inline-formula><math xmlns="http://www.w3.org/1998/Math/MathML" display="inline"><semantics><mrow><msub><mrow><mover accent="true"><mrow><mi>A</mi><mi>H</mi><mi>R</mi><mi>R</mi></mrow><mo stretchy="true">˜</mo></mover></mrow><mrow><mn>24</mn><mi>h</mi><mi>r</mi></mrow></msub></mrow></semantics></math></inline-formula>) compared with other parameters obtained from the Holter monitor in patients with newly diagnosed AF. <b>Material and Methods:</b> A total of 30 parameters obtained from 521 persistent AF patients’ Holter monitor were analyzed retrospectively from 1 January 2010 to 31 July 2014. Every patient was followed up to the occurrence of death or the end of 30 June 2017. <b>Results:</b><inline-formula><math xmlns="http://www.w3.org/1998/Math/MathML" display="inline"><semantics><mrow><msub><mrow><mover accent="true"><mrow><mi>A</mi><mi>H</mi><mi>R</mi><mi>R</mi></mrow><mo stretchy="true">˜</mo></mover></mrow><mrow><mn>24</mn><mi>h</mi><mi>r</mi></mrow></msub></mrow></semantics></math></inline-formula> was the most feasible Holter parameter. Lower <inline-formula><math xmlns="http://www.w3.org/1998/Math/MathML" display="inline"><semantics><mrow><msub><mrow><mover accent="true"><mrow><mi>A</mi><mi>H</mi><mi>R</mi><mi>R</mi></mrow><mo stretchy="true">˜</mo></mover></mrow><mrow><mn>24</mn><mi>h</mi><mi>r</mi></mrow></msub></mrow></semantics></math></inline-formula> was associated with increased risk of all-cause mortality (adjusted hazard ratio [aHR] for every 10-bpm reduction: 2.70, 95% confidence interval [CI]: 1.75–4.17, <i>p</i> < 0.001). The C-statistic of <inline-formula><math xmlns="http://www.w3.org/1998/Math/MathML" display="inline"><semantics><mrow><msub><mrow><mover accent="true"><mrow><mi>A</mi><mi>H</mi><mi>R</mi><mi>R</mi></mrow><mo stretchy="true">˜</mo></mover></mrow><mrow><mn>24</mn><mi>h</mi><mi>r</mi></mrow></msub></mrow></semantics></math></inline-formula> alone was 0.707 (95% CI: 0.658–0.756), and 0.697 (95% CI: 0.650–0.744) for the CHA2DS2-VASc score alone. By combining <inline-formula><math xmlns="http://www.w3.org/1998/Math/MathML" display="inline"><semantics><mrow><msub><mrow><mover accent="true"><mrow><mi>A</mi><mi>H</mi><mi>R</mi><mi>R</mi></mrow><mo stretchy="true">˜</mo></mover></mrow><mrow><mn>24</mn><mi>h</mi><mi>r</mi></mrow></msub></mrow></semantics></math></inline-formula> with the CHA2DS2-VASc score, the C-statistic could improve to 0.764 (95% CI: 0.722–0.806). While using 20 bpm as the cut-off value, the aHR was 3.66 (95% CI: 2.05–6.52) for patients with <inline-formula><math xmlns="http://www.w3.org/1998/Math/MathML" display="inline"><semantics><mrow><msub><mrow><mover accent="true"><mrow><mi>A</mi><mi>H</mi><mi>R</mi><mi>R</mi></mrow><mo stretchy="true">˜</mo></mover></mrow><mrow><mn>24</mn><mi>h</mi><mi>r</mi></mrow></msub></mrow></semantics></math></inline-formula> < 20 bpm in contrast to patients with <inline-formula><math xmlns="http://www.w3.org/1998/Math/MathML" display="inline"><semantics><mrow><msub><mrow><mover accent="true"><mrow><mi>A</mi><mi>H</mi><mi>R</mi><mi>R</mi></mrow><mo stretchy="true">˜</mo></mover></mrow><mrow><mn>24</mn><mi>h</mi><mi>r</mi></mrow></msub></mrow></semantics></math></inline-formula> ≥ 20 bpm. <b>Conclusions:</b><inline-formula><math xmlns="http://www.w3.org/1998/Math/MathML" display="inline"><semantics><mrow><msub><mrow><mover accent="true"><mrow><mi>A</mi><mi>H</mi><mi>R</mi><mi>R</mi></mrow><mo stretchy="true">˜</mo></mover></mrow><mrow><mn>24</mn><mi>h</mi><mi>r</mi></mrow></msub></mrow></semantics></math></inline-formula> could be helpful for risk stratification for AF in addition to the CHA2DS2-VASc score.Hsing-Yu ChenJohn MalikHau-Tieng WuChun-Li WangMDPI AGarticleall-cause mortalityatrial fibrillationHolter monitorthe median hourly ambulatory heart rate rangeMedicineRENJournal of Personalized Medicine, Vol 11, Iss 1202, p 1202 (2021)

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