BACKGROUND: Alterations in autonomic tone and/or sinus node dysfunction are common with aging. We hypothesized that older persons with low or high heart rates represent a population with subclinical abnormalities who are more likely to develop atrial fibrillation (AF). METHODS: A total of 5,226 participants aged 65 years or more (85% white; 42% male) with complete data from the Cardiovascular Health Study were used in this analysis. AF cases were identified during the yearly study electrocardiograms, participant history of a physician diagnosis, or by hospitalization data. Cox regression was used to compute hazard ratios (HR) and 95% confidence intervals (CI) for the association between resting heart rate and incident AF using clinically relevant categories (heart rate ≤60 beats/min, 60< heart rate beats/min ≤90 beats/min (reference), heart rate >90 beats/min) and as a continuous variable per 5 beats/min decrease. RESULTS: Over a median follow-up of 12.7 years, a total of 532 (10.2%) participants developed AF. In a multivariable Cox regression analysis, heart rates ≤60 beats/min (HR = 1.3, 95% CI = 1.1, 1.5), but not >90 beats/min (HR = 1.1, 95% CI = 0.52, 2.3), were associated with an increased risk of AF. Additionally, heart rate per 5 beats/min decrease was associated with an increased risk of AF (HR = 1.06, 95% CI = 1.01, 1.1). The results were consistent in subgroup analyses stratified by age, sex, race, and baseline cardiovascular disease. CONCLUSION: In the elderly, low heart rates are associated with an increased risk of AF. Potentially, underlying alterations in autonomic tone and/or subclinical sinus node dysfunction manifested as slow heart rate predispose to AF.
BACKGROUND: Alterations in autonomic tone and/or sinus node dysfunction are common with aging. We hypothesized that older persons with low or high heart rates represent a population with subclinical abnormalities who are more likely to develop atrial fibrillation (AF). METHODS: A total of 5,226 participants aged 65 years or more (85% white; 42% male) with complete data from the Cardiovascular Health Study were used in this analysis. AF cases were identified during the yearly study electrocardiograms, participant history of a physician diagnosis, or by hospitalization data. Cox regression was used to compute hazard ratios (HR) and 95% confidence intervals (CI) for the association between resting heart rate and incident AF using clinically relevant categories (heart rate ≤60 beats/min, 60< heart rate beats/min ≤90 beats/min (reference), heart rate >90 beats/min) and as a continuous variable per 5 beats/min decrease. RESULTS: Over a median follow-up of 12.7 years, a total of 532 (10.2%) participants developed AF. In a multivariable Cox regression analysis, heart rates ≤60 beats/min (HR = 1.3, 95% CI = 1.1, 1.5), but not >90 beats/min (HR = 1.1, 95% CI = 0.52, 2.3), were associated with an increased risk of AF. Additionally, heart rate per 5 beats/min decrease was associated with an increased risk of AF (HR = 1.06, 95% CI = 1.01, 1.1). The results were consistent in subgroup analyses stratified by age, sex, race, and baseline cardiovascular disease. CONCLUSION: In the elderly, low heart rates are associated with an increased risk of AF. Potentially, underlying alterations in autonomic tone and/or subclinical sinus node dysfunction manifested as slow heart rate predispose to AF.
Authors: Koki Nakanishi; Marco R Di Tullio; Min Qian; John L P Thompson; Arthur J Labovitz; Douglas L Mann; Ralph L Sacco; Patrick M Pullicino; Ronald S Freudenberger; John R Teerlink; Susan Graham; Gregory Y H Lip; Bruce Levin; Jay P Mohr; Richard Buchsbaum; Conrado J Estol; Dirk J Lok; Piotr Ponikowski; Stefan D Anker; Shunichi Homma Journal: Cerebrovasc Dis Date: 2017-04-19 Impact factor: 2.762
Authors: Wesley T O'Neal; Waqas T Qureshi; Michael J Blaha; Zeina A Dardari; Jonathan K Ehrman; Clinton A Brawner; Elsayed Z Soliman; Mouaz H Al-Mallah Journal: JACC Clin Electrophysiol Date: 2016-11
Authors: Wesley T O'Neal; Waqas T Qureshi; Suzanne E Judd; James F Meschia; Virginia J Howard; George Howard; Elsayed Z Soliman Journal: Int J Stroke Date: 2015-08-26 Impact factor: 5.266
Authors: J E Siland; B Geelhoed; C Roselli; B Wang; H J Lin; S Weiss; S Trompet; M E van den Berg; E Z Soliman; L Y Chen; I Ford; J W Jukema; P W Macfarlane; J Kornej; H Lin; K L Lunetta; M Kavousi; J A Kors; M A Ikram; X Guo; J Yao; M Dörr; S B Felix; U Völker; N Sotoodehnia; D E Arking; B H Stricker; S R Heckbert; S A Lubitz; E J Benjamin; A Alonso; P T Ellinor; P van der Harst; M Rienstra Journal: PLoS One Date: 2022-05-20 Impact factor: 3.240