Heart rate fluctuation predicts mortality in critically ill patients in the intensive care unit: a retrospective cohort study

Abstract

Background: To evaluate the association between heart rate (HR) fluctuation and mortality in critically ill patients in the intensive care unit (ICU). Methods: A total of 27,814 patients were enrolled from the Medical Information Mart for Intensive Care database and were divided into 3 groups: low HR fluctuation [<25 beats per minute (bpm)], control (25-34 bpm), and high HR fluctuation (≥35 bpm), based on the initial 24-hour HR fluctuation (calculated as the maximum HR minus minimum HR). Multivariate Cox regression and restricted cubic spline models were used.Results: Compared to the control group, higher risk of 28-day and 1-year mortality remained significant in an adjusted model, with hazard ratios of 1.210 [95% confidence interval (CI), 1.103-1.327] and 1.150 (95% CI, 1.078-1.227), respectively, in the high HR fluctuation group, as well as hazard ratios of 1.130 (95% CI, 1.035-1.232) and 1.087 (95% CI, 1.022-1.157), respectively, in the low HR fluctuation group. Restricted cubic splines showed a U-type curve, with the lowest risk of mortality at an HR fluctuation of 30 bpm.Conclusions: This retrospective cohort study revealed that both high and low HR fluctuation correlated with increased mortality in critically ill ICU patients, providing new insights for optimizing HR control strategies.

Heart Rate Fluctuation and Mortality in Critically Ill Myocardial Infarction Patients: A Retrospective Cohort Study

“…Recently, HR fluctuation was demonstrated to predict mortality and hospitalization in chronic heart failure (6). Another study showed that both high and low HR fluctuation were harmful for survival of critically ill patients in ICU (7). However, this current study focused on MI patients and found that HR fluctuation was positively associated with 30-day mortality and 1-year mortality in MI patients, emphasizing its feasibility and importance for outcome prediction of MI.…”

“…As a common kind of physiological change, HR also shows an obvious fluctuation across 24 h. It has been reported that the fluctuation range of HR was an easily available prognostic predictor for chronic heart failure, which might be correlated with autonomic tone and exercise capacity (6). Recently, we reported that both high and low HR fluctuation were associated with higher mortality in ICU (7). Nevertheless, the association between HR fluctuation and the risk of mortality in MI patients remains unknown.…”

Admission Resting Heart Rate as an Independent Predictor of All-Cause Mortality in Elderly Patients with Hip Fracture

“…Also, the U-shaped curve was seen in critically ill patients, providing a new insight for optimizing HR control strategies. 20 Yet, other studies observed a J-shaped association in acute ischemic stroke patients, 21 myocardial infarction patients, 22 and even in the general population. 23 In agreement with the latter observations, we also observed a typical J-shaped curve for the association between RHR and 1-year mortality, and 70 bpm exhibited the lowest mortality risk.…”

“…Also, the U-shaped curve was seen in critically ill patients, providing a new insight for optimizing HR control strategies. 20 Yet, other studies observed a J-shaped association in acute ischemic stroke patients, 21 myocardial infarction patients, 22…”

Bradycardia and Heart Rate Fluctuation Are Associated with a Prolonged Intensive Care Unit Stay in Patients with Severe COVID-19

“…Our study also found that the patients with bradycardia had high HR fluctuation. One study demonstrated a higher risk of 28-day and one-year mortality in critically ill ICU patients with high HR fluctuations of more than or equal to 35 bpm [ 29 ]. After adjusting for other confounders, the high HR fluctuation was found to be associated with a longer ICU-LOS.…”