Sangeeta Lachman1, Michel S Terbraak2, Jacqueline Limpens3, Harald Jorstad4, Cees Lucas5, Wilma Scholte Op Reimer2, S Matthijs Boekholdt4, Gerben Ter Riet6, Ron J G Peters4. 1. Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands. Electronic address: sangeeta.lachman@gmail.com. 2. Achieve Amsterdam University of Applied Sciences, Amsterdam, the Netherlands. 3. Medical Library, Academic Medical Center, Amsterdam, the Netherlands. 4. Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands. 5. Department of Biostatistics, Academic Medical Center, Amsterdam, the Netherlands. 6. Achieve Amsterdam University of Applied Sciences, Amsterdam, the Netherlands; Department of General Practice, Academic Medical Center, Amsterdam, the Netherlands.
Abstract
BACKGROUND: Routine outpatient care of patients with coronary artery disease (CAD) lacks a simple measure of physical fitness and risk of mortality. Heart rate recovery (HRR) is noninvasive and easily obtainable in outpatient settings. Prior studies have suggested that delayed postexercise HRR in the first minutes is associated with mortality in several types of populations. However, a comprehensive overview of the prognostic value of delayed HRR for time to mortality specifically in CAD patients is not available. The purpose of the current meta-analysis is to evaluate the prognostic value of delayed HRR in CAD patients. METHODS: We conducted a systematic search in OVID MEDLINE and OVID EMBASE to identify studies reporting on HRR and risk of incident cardiovascular events or mortality in CAD patients. Hazard ratios for delayed versus nondelayed HRR were pooled using random-effects meta-analysis. RESULTS: Four studies were included, comprising 2,428 CAD patients. The study quality of the included studies was rated moderate (n = 2) to high (n = 2). Delayed HRR was defined by ≤12 to ≤21 beat/min in the recovery period. During follow-up (range 2.0-9.8 years), 151 patients died (6.2% [range 2.5%-19.5%]). Only data on mortality could be pooled. Heterogeneity was limited (I2 = 32%; P = .23); pooled unadjusted hazard ratio for mortality, based on 3 studies, was 5.8 (95% CI 3.2-10.4). CONCLUSIONS: In CAD patients, delayed HRR is significantly associated with all-cause mortality. As exercise testing is performed routinely in CAD patients, HRR can be considered in monitoring exercise; still, further research must investigate the addition of HRR in current risk scores.
BACKGROUND: Routine outpatient care of patients with coronary artery disease (CAD) lacks a simple measure of physical fitness and risk of mortality. Heart rate recovery (HRR) is noninvasive and easily obtainable in outpatient settings. Prior studies have suggested that delayed postexercise HRR in the first minutes is associated with mortality in several types of populations. However, a comprehensive overview of the prognostic value of delayed HRR for time to mortality specifically in CAD patients is not available. The purpose of the current meta-analysis is to evaluate the prognostic value of delayed HRR in CAD patients. METHODS: We conducted a systematic search in OVID MEDLINE and OVID EMBASE to identify studies reporting on HRR and risk of incident cardiovascular events or mortality in CAD patients. Hazard ratios for delayed versus nondelayed HRR were pooled using random-effects meta-analysis. RESULTS: Four studies were included, comprising 2,428 CAD patients. The study quality of the included studies was rated moderate (n = 2) to high (n = 2). Delayed HRR was defined by ≤12 to ≤21 beat/min in the recovery period. During follow-up (range 2.0-9.8 years), 151 patients died (6.2% [range 2.5%-19.5%]). Only data on mortality could be pooled. Heterogeneity was limited (I2 = 32%; P = .23); pooled unadjusted hazard ratio for mortality, based on 3 studies, was 5.8 (95% CI 3.2-10.4). CONCLUSIONS: In CAD patients, delayed HRR is significantly associated with all-cause mortality. As exercise testing is performed routinely in CAD patients, HRR can be considered in monitoring exercise; still, further research must investigate the addition of HRR in current risk scores.
Authors: Jhansi Dyavanapalli; Jeannette Rodriguez; Carla Rocha Dos Santos; Joan B Escobar; Mary Kate Dwyer; John Schloen; Kyung-Min Lee; Whitney Wolaver; Xin Wang; Olga Dergacheva; Lisete C Michelini; Kathryn J Schunke; Christopher F Spurney; Matthew W Kay; David Mendelowitz Journal: JACC Basic Transl Sci Date: 2020-05-25
Authors: Nathaniel T Berry; Emily Bechke; Lenka H Shriver; Susan D Calkins; Susan P Keane; Lilly Shanahan; Laurie Wideman Journal: Front Physiol Date: 2021-02-05 Impact factor: 4.566