Long-term mortality risk in patients with an implantable cardioverter-defibrillator

Influence of heart rate and QRS duration

M.T. Hoogwegt, D.A.M.J. Theuns, S.S. Pedersen, N. Kupper

Research output: Contribution to journalArticleScientificpeer-review

Abstract

Background
A paucity of studies has investigated the role of autonomic cardiac regulation as well as cardiac conduction in relation to prognosis in implantable cardioverter–defibrillator (ICD) patients. Therefore, we examined the association of heart rate and QRS duration with long-term mortality risk in first-time ICD patients, adjusting also for measures of emotional distress.
Methods
Resting heart rate and QRS duration were assessed prior to ICD implantation in 448 patients. Primary study endpoint was all-cause mortality (up to 6.0 year follow-up, median follow-up of 5.6 years (IQR: 1.9)). The impact of heart rate and QRS duration on time to all-cause mortality was separately assessed with Cox proportional hazard regression analysis, adjusting for clinical factors and symptoms of depression and anxiety.
Results
Mean (SD) heart rate was 68.0 ± 13.3 bpm and mean QRS duration was 130.9 ± 36.9 ms. Heart rate of ≥ 80 bpm was associated with increased risk of mortality (HR = 1.86; 95% CI = 1.15–3.00; p = .011) in unadjusted analysis. In adjusted analyses, this relationship remained significant both with depression (HR = 1.86, 95% CI = 1.12–3.09; p = .017) and anxiety (HR = 1.82, 95% CI = 1.10–3.03; p = .021) and clinical measures as covariates. QRS duration of ≥ 120 ms was associated with impaired prognosis in unadjusted analysis (HR = 2.00, 95% CI = 1.27–3.14; p = .003), but was reduced to non-significance in adjusted analysis when medical comorbidities were included (HR = 1.15, 95% CI = 0.70–1.89; p = .60).
Conclusions
This study shows that increased heart rate is associated with impaired prognosis. Since heart rate is a relatively easy measurable parameter of autonomic functioning, heart rate should be included as a measure for risk stratification in daily clinical practice.
Keywords: Heart rate, QRS duration, Mortality, Implantable cardioverter–defibrillator
Original languageEnglish
Pages (from-to)560-564
JournalInternational Journal of Cardiology
Volume175
Issue number3
DOIs
Publication statusPublished - 2014

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Implantable Defibrillators
Depression
Comorbidity

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@article{92786f88a3554a948f0f9f18e96c8beb,
title = "Long-term mortality risk in patients with an implantable cardioverter-defibrillator: Influence of heart rate and QRS duration",
abstract = "BackgroundA paucity of studies has investigated the role of autonomic cardiac regulation as well as cardiac conduction in relation to prognosis in implantable cardioverter–defibrillator (ICD) patients. Therefore, we examined the association of heart rate and QRS duration with long-term mortality risk in first-time ICD patients, adjusting also for measures of emotional distress.MethodsResting heart rate and QRS duration were assessed prior to ICD implantation in 448 patients. Primary study endpoint was all-cause mortality (up to 6.0 year follow-up, median follow-up of 5.6 years (IQR: 1.9)). The impact of heart rate and QRS duration on time to all-cause mortality was separately assessed with Cox proportional hazard regression analysis, adjusting for clinical factors and symptoms of depression and anxiety.ResultsMean (SD) heart rate was 68.0 ± 13.3 bpm and mean QRS duration was 130.9 ± 36.9 ms. Heart rate of ≥ 80 bpm was associated with increased risk of mortality (HR = 1.86; 95{\%} CI = 1.15–3.00; p = .011) in unadjusted analysis. In adjusted analyses, this relationship remained significant both with depression (HR = 1.86, 95{\%} CI = 1.12–3.09; p = .017) and anxiety (HR = 1.82, 95{\%} CI = 1.10–3.03; p = .021) and clinical measures as covariates. QRS duration of ≥ 120 ms was associated with impaired prognosis in unadjusted analysis (HR = 2.00, 95{\%} CI = 1.27–3.14; p = .003), but was reduced to non-significance in adjusted analysis when medical comorbidities were included (HR = 1.15, 95{\%} CI = 0.70–1.89; p = .60).ConclusionsThis study shows that increased heart rate is associated with impaired prognosis. Since heart rate is a relatively easy measurable parameter of autonomic functioning, heart rate should be included as a measure for risk stratification in daily clinical practice.Keywords: Heart rate, QRS duration, Mortality, Implantable cardioverter–defibrillator",
author = "M.T. Hoogwegt and D.A.M.J. Theuns and S.S. Pedersen and N. Kupper",
year = "2014",
doi = "10.1016/j.ijcard.2014.06.030",
language = "English",
volume = "175",
pages = "560--564",
journal = "International Journal of Cardiology",
issn = "0167-5273",
publisher = "Elsevier Ireland Ltd",
number = "3",

}

Long-term mortality risk in patients with an implantable cardioverter-defibrillator : Influence of heart rate and QRS duration. / Hoogwegt, M.T.; Theuns, D.A.M.J.; Pedersen, S.S.; Kupper, N.

In: International Journal of Cardiology, Vol. 175, No. 3, 2014, p. 560-564.

Research output: Contribution to journalArticleScientificpeer-review

TY - JOUR

T1 - Long-term mortality risk in patients with an implantable cardioverter-defibrillator

T2 - Influence of heart rate and QRS duration

AU - Hoogwegt, M.T.

AU - Theuns, D.A.M.J.

AU - Pedersen, S.S.

AU - Kupper, N.

PY - 2014

Y1 - 2014

N2 - BackgroundA paucity of studies has investigated the role of autonomic cardiac regulation as well as cardiac conduction in relation to prognosis in implantable cardioverter–defibrillator (ICD) patients. Therefore, we examined the association of heart rate and QRS duration with long-term mortality risk in first-time ICD patients, adjusting also for measures of emotional distress.MethodsResting heart rate and QRS duration were assessed prior to ICD implantation in 448 patients. Primary study endpoint was all-cause mortality (up to 6.0 year follow-up, median follow-up of 5.6 years (IQR: 1.9)). The impact of heart rate and QRS duration on time to all-cause mortality was separately assessed with Cox proportional hazard regression analysis, adjusting for clinical factors and symptoms of depression and anxiety.ResultsMean (SD) heart rate was 68.0 ± 13.3 bpm and mean QRS duration was 130.9 ± 36.9 ms. Heart rate of ≥ 80 bpm was associated with increased risk of mortality (HR = 1.86; 95% CI = 1.15–3.00; p = .011) in unadjusted analysis. In adjusted analyses, this relationship remained significant both with depression (HR = 1.86, 95% CI = 1.12–3.09; p = .017) and anxiety (HR = 1.82, 95% CI = 1.10–3.03; p = .021) and clinical measures as covariates. QRS duration of ≥ 120 ms was associated with impaired prognosis in unadjusted analysis (HR = 2.00, 95% CI = 1.27–3.14; p = .003), but was reduced to non-significance in adjusted analysis when medical comorbidities were included (HR = 1.15, 95% CI = 0.70–1.89; p = .60).ConclusionsThis study shows that increased heart rate is associated with impaired prognosis. Since heart rate is a relatively easy measurable parameter of autonomic functioning, heart rate should be included as a measure for risk stratification in daily clinical practice.Keywords: Heart rate, QRS duration, Mortality, Implantable cardioverter–defibrillator

AB - BackgroundA paucity of studies has investigated the role of autonomic cardiac regulation as well as cardiac conduction in relation to prognosis in implantable cardioverter–defibrillator (ICD) patients. Therefore, we examined the association of heart rate and QRS duration with long-term mortality risk in first-time ICD patients, adjusting also for measures of emotional distress.MethodsResting heart rate and QRS duration were assessed prior to ICD implantation in 448 patients. Primary study endpoint was all-cause mortality (up to 6.0 year follow-up, median follow-up of 5.6 years (IQR: 1.9)). The impact of heart rate and QRS duration on time to all-cause mortality was separately assessed with Cox proportional hazard regression analysis, adjusting for clinical factors and symptoms of depression and anxiety.ResultsMean (SD) heart rate was 68.0 ± 13.3 bpm and mean QRS duration was 130.9 ± 36.9 ms. Heart rate of ≥ 80 bpm was associated with increased risk of mortality (HR = 1.86; 95% CI = 1.15–3.00; p = .011) in unadjusted analysis. In adjusted analyses, this relationship remained significant both with depression (HR = 1.86, 95% CI = 1.12–3.09; p = .017) and anxiety (HR = 1.82, 95% CI = 1.10–3.03; p = .021) and clinical measures as covariates. QRS duration of ≥ 120 ms was associated with impaired prognosis in unadjusted analysis (HR = 2.00, 95% CI = 1.27–3.14; p = .003), but was reduced to non-significance in adjusted analysis when medical comorbidities were included (HR = 1.15, 95% CI = 0.70–1.89; p = .60).ConclusionsThis study shows that increased heart rate is associated with impaired prognosis. Since heart rate is a relatively easy measurable parameter of autonomic functioning, heart rate should be included as a measure for risk stratification in daily clinical practice.Keywords: Heart rate, QRS duration, Mortality, Implantable cardioverter–defibrillator

U2 - 10.1016/j.ijcard.2014.06.030

DO - 10.1016/j.ijcard.2014.06.030

M3 - Article

VL - 175

SP - 560

EP - 564

JO - International Journal of Cardiology

JF - International Journal of Cardiology

SN - 0167-5273

IS - 3

ER -