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Resting heart rate as a tool for risk stratification in primary care: does it provide incremental prognostic information?

Abstract：

BACKGROUND:Several selected population-based studies have emphasized the significance of resting heart rate as an independent cardiovascular risk factor. However, there are no data available for using resting heart rate as a cardiovascular risk predictor in contemporary primary care. Thus, the aim of our analysis was to examine the clinical value of the measurement of resting heart rate in a large, unselected population-based cohort of primary care subjects under the conditions of contemporary primary prevention. DESIGN:Prospective, population-based cohort study. METHODS:We examined a subgroup of 5320 unselected primary care subjects free of coronary artery disease from the nationwide, longitudinal Diabetes Cardiovascular Risk Evaluation Targets and Essential Data for Commitment of Treatment (DETECT) cohort study, which was conducted from 2003 to 2008. RESULTS:During the follow-up time of 5 years, 258 events were reported. Elevated resting heart rate was not associated with an increased risk for cardiovascular events (HR = 0.75, p = 0.394), cardiovascular mortality (HR = 0.71, p = 0.616) or major cardiovascular events (HR = 0.77, p = 0.376). By cross-sectional analysis, elevated heart rate clustered with markers of the metabolic syndrome, like increased blood pressure (systolic: OR = 5.54, p < 0.0001; diastolic: OR = 3.82, p < 0.0001), elevated fasting plasma glucose levels (OR = 8.84, p < 0.0001), hypertriglyceridaemia (OR = 22.16, p = 0.001), and obesity (body mass index OR = 0.89, p < 0.0001). Assessment of resting heart rate in clinical practice had minimal and non-significant additional prognostic value compared to established cardiovascular risk factors as judged by C statistics (C = 0.001, p = 0.979). CONCLUSION:The measurement of resting heart rate in the daily routine of primary care does not provide incremental prognostic information for cardiovascular risk stratification.

journal_name

Eur J Prev Cardiol

journal_title

European journal of preventive cardiology

authors

Leistner DM,Klotsche J,Palm S,Pieper L,Stalla GK,Lehnert H,Silber S,März W,Wittchen HU,Zeiher AM,DETECT-Study Group.

doi

10.1177/1741826710394304

subject

Has Abstract

pub_date

2012-04-01 00:00:00

pages

275-84

issue

eissn

2047-4873

issn

2047-4881

pii

1741826710394304

journal_volume

pub_type

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Resting heart rate as a tool for risk stratification in primary care: does it provide incremental prognostic information?