Background
Elevated resting heart rate is a risk factor for cardiovascular events.
Objective
The purpose of this study was to investigate the clinical significance of nocturnal
heart rate (nHR) and 24-hour mean heart rate (24h-HR) obtained by continuous remote
monitoring (RM) of implantable devices.
Methods
We analyzed daily-sampled trends of nHR, 24h-HR, and physical activity in patients
on β-blocker therapy for chronic heart failure and with implantable cardioverter-defibrillators
or cardiac resynchronization therapy defibrillators (CRT-Ds). Patients were grouped
by average nHR and 24h-HR quartile during follow-up to estimate the respective incidence
of nonarrhythmic death and device-treated ventricular tachycardia/fibrillation (VT/VF).
Results
The study cohort included 1330 patients (median age 69 years [interquartile range
61–77 years]; 41% [n = 550] with CRT-D; median follow-up 25 months [interquartile
range 13–42 months]). Compared with patients in the lowest nHR quartile (≤57 beats/min)
group, patients in the highest quartile group (>65 beats/min) had an increased risk
of nonarrhythmic death (adjusted hazard ratio [AHR] 2.25; 95% confidence interval
[CI] 1.13–4.50; P = .021) and VT/VF (AHR 1.98; 95% CI 1.40–2.79; P < .001) and were characterized by the lowest level of physical activity (P ≤ .0004 vs every other nHR quartiles). The highest 24h-HR quartile group (>75 beats/min)
showed an increased risk of VT/VF (AHR 2.13; 95% CI 1.52–2.99; P < .001) and a weaker though significant association with nonarrhythmic mortality
(AHR 1.80; 95% CI 1.00–3.22; P = .05) as compared with the lowest 24h-HR quartile group (≤65 beats/min).
Conclusion
In remotely monitored patients with implantable cardioverter-defibrillator/CRT-D on
β-blocker therapy for heart failure, elevated heart rates (nHR >65 beats/min and 24h-HR
>75 beats/min) were associated with increased mortality and VT/VF risk. nHR showed
a stronger association than 24h-HR with worst prognosis and lowest physical activity.
Keywords
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Article info
Publication history
Published online: October 27, 2022
Publication stage
In Press Journal Pre-ProofFootnotes
Funding Sources: Manuscript editing was partially supported by Biotronik Italia S.p.A., an affiliate of BIOTRONIK SE & Co. KG, Berlin, Germany (Via Alessandro Volta 16, 20093, Cologno Monzese (MI), Italy). No other funds have been received to support this work.
Disclosures: Mr Giacopelli and Mr Gargaro are employees of Biotronik Italia.
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- Role of remote monitoring–derived heart rates in the risk stratification of heart failure with reduced ejection fraction: New insightsHeart Rhythm
- PreviewIn BC 2600, Gilgamesh, the king of the Mesopotamian Epic of Gilgamesh, lamented the death of his best friend and recorded the passage “I touch his heart but it does not beat at all.”1 This passage was felt to be the earliest reference of a pulse, and it reflected intimate knowledge of the heartbeat and mortality.
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