Resting heart rate, heart rate variability and functional decline in old age

Background: Heart rate and heart rate variability, markers of cardiac autonomic function, have been linked with cardiovascular disease. We investigated whether heart rate and heart rate variability are associated with functional status in older adults, independent of cardiovascular disease. Methods: We obtained data from the Prospective Study of Pravastatin in the Elderly at Risk (PROSPER). A total of 5042 participants were included in the present study, and mean follow-up was 3.2 years. Heart rate and heart rate variability were derived from baseline 10-second electrocardiograms. Heart rate variability was defined as the standard deviation of normal-to-normal RR intervals (SDNN). Functional status in basic (ADL) and instrumental (IADL) activities of daily living was measured using Barthel and Lawton scales, at baseline and during follow-up. Results: The mean age of the study population was 75.3 years. At baseline, higher heart rate was associated with worse ADL and IADL, and lower SDNN was related to worse IADL (all p values < 0.05). Participants in the highest tertile of heart rate (range 71–117 beats/min) had a 1.79-fold (95% confidence interval [CI] 1.45–2.22) and 1.35-fold (95% CI 1.12–1.63) higher risk of decline in ADL and IADL, respectively (p for trend < 0.001 and 0.001, respectively). Participants in the lowest tertile of SDNN (range 1.70–13.30 ms) had 1.21-fold (95% CI 1.00–1.46) and 1.25-fold (95% CI 1.05–1.48) higher risk of decline in ADL and IADL, respectively (both p for trends < 0.05). All associations were independent of sex, medications, cardiovascular risk factors and comorbidities. Interpretation: Higher resting heart rate and lower heart rate variability were associated with worse functional status and with higher risk of future functional decline in older adults, independent of cardiovascular disease. This study provides insight into the role of cardiac autonomic function in the development of functional decline.

[1]  F. Mahoney,et al.  FUNCTIONAL EVALUATION: THE BARTHEL INDEX. , 2018, Maryland state medical journal.

[2]  J. Tardif,et al.  Ivabradine in stable coronary artery disease without clinical heart failure. , 2014, The New England journal of medicine.

[3]  D. Mozaffarian,et al.  Physical Activity and Heart Rate Variability in Older Adults: The Cardiovascular Health Study , 2014, Circulation.

[4]  J. Sacha,et al.  Why should one normalize heart rate variability with respect to average heart rate , 2013, Front. Physiol..

[5]  S. Yusuf,et al.  Impact of resting heart rate on mortality, disability and cognitive decline in patients after ischaemic stroke. , 2012, European heart journal.

[6]  Seok‐Min Kang,et al.  Ivabradine and outcomes in chronic heart failure , 2010, The Lancet.

[7]  U. Laufs,et al.  Vascular pathophysiology in response to increased heart rate. , 2010, Journal of the American College of Cardiology.

[8]  Michael Böhm,et al.  Ivabradine and outcomes in chronic heart failure (SHIFT): a randomised placebo-controlled study , 2010, The Lancet.

[9]  Warren J Manning,et al.  Cardiac Index Is Associated With Brain Aging: The Framingham Heart Study , 2010, Circulation.

[10]  K. Felmingham,et al.  Impact of Depression and Antidepressant Treatment on Heart Rate Variability: A Review and Meta-Analysis , 2010, Biological Psychiatry.

[11]  R. Varadhan,et al.  Frailty and impaired cardiac autonomic control: new insights from principal components aggregation of traditional heart rate variability indices. , 2009, The journals of gerontology. Series A, Biological sciences and medical sciences.

[12]  Yuru Zhong,et al.  Limbic dysregulation is associated with lowered heart rate variability and increased trait anxiety in healthy adults , 2009, Human brain mapping.

[13]  F. Zitman,et al.  Association between major depressive disorder and heart rate variability in the Netherlands Study of Depression and Anxiety (NESDA). , 2008, Archives of general psychiatry.

[14]  R. Ferrari,et al.  Ivabradine for patients with stable coronary artery disease and left-ventricular systolic dysfunction (BEAUTIFUL): a randomised, double-blind, placebo-controlled trial , 2008, The Lancet.

[15]  Ravi Varadhan,et al.  Physiological Complexity Underlying Heart Rate Dynamics and Frailty Status in Community‐Dwelling Older Women , 2008, Journal of the American Geriatrics Society.

[16]  Jean-Claude Tardif,et al.  Resting heart rate in cardiovascular disease. , 2007, Journal of the American College of Cardiology.

[17]  Ryusuke Inoue,et al.  Ambulatory blood pressure, blood pressure variability and the prevalence of carotid artery alteration: the Ohasama study , 2007, Journal of hypertension.

[18]  E. Edelman,et al.  Role of endothelial shear stress in the natural history of coronary atherosclerosis and vascular remodeling: molecular, cellular, and vascular behavior. , 2007, Journal of the American College of Cardiology.

[19]  A. Loewy,et al.  Autonomic brainstem nuclei are linked to the hippocampus , 2005, Neuroscience.

[20]  G. Parati,et al.  Blood pressure variability and silent cerebral damage in essential hypertension. , 2004, American journal of hypertension.

[21]  Peter W Macfarlane,et al.  Can cardiac vagal tone be estimated from the 10-second ECG? , 2004, International journal of cardiology.

[22]  H. Hein,et al.  Increased heart rate and reduced heart-rate variability are associated with subclinical inflammation in middle-aged and elderly subjects with no apparent heart disease. , 2004, European heart journal.

[23]  F. Yasuma,et al.  Respiratory sinus arrhythmia: why does the heartbeat synchronize with respiratory rhythm? , 2004, Chest.

[24]  P. Macfarlane,et al.  Pravastatin in elderly individuals at risk of vascular disease (PROSPER): a randomised controlled trial , 2002, The Lancet.

[25]  P. Macfarlane,et al.  The design of a prospective study of Pravastatin in the Elderly at Risk (PROSPER). PROSPER Study Group. PROspective Study of Pravastatin in the Elderly at Risk. , 1999, The American journal of cardiology.

[26]  R. Sloan,et al.  Blood pressure variability responses to tilt are buffered by cardiac autonomic control. , 1997, The American journal of physiology.

[27]  R. Sloan,et al.  Cardiac autonomic control is inversely related to blood pressure variability responses to psychological challenge. , 1997, The American journal of physiology.

[28]  A. Malliani,et al.  Heart rate variability. Standards of measurement, physiological interpretation, and clinical use , 1996 .

[29]  Kyuhyun Wang,et al.  Hemodynamic Predictors of Myocardial Oxygen Consumption During Static and Dynamic Exercise , 1974, Circulation.

[30]  M. Lawton.  THE FUNCTIONAL ASSESSMENT OF ELDERLY PEOPLE , 1971, Journal of the American Geriatrics Society.

[31]  S. Attar,et al.  Mitral valve replacement. , 1965, Maryland state medical journal.

[32]  Athanase Benetos,et al.  Impact of Increased Heart Rate on Clinical Outcomes in Hypertension , 2012, Drugs.

[33]  Kelly R Evenson,et al.  Physical activity as a preventative factor for frailty: the health, aging, and body composition study. , 2009, The journals of gerontology. Series A, Biological sciences and medical sciences.

[34]  P. Macfarlane,et al.  The university of glasgow (Uni-G) ECG analysis program , 2005, Computers in Cardiology, 2005.

[35]  M. Malik.  Heart rate variability. Standards of measurement, physiological interpretation, and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. , 1996, European heart journal.