Abstract 12634: The Association of 24-hour Holter-Derived Heart Rate Variability With Incident Heart Failure in the Cardiovascular Health Study
Background: Abnormal heart rate variability (HRV) has been used to predict multiple adverse cardiovascular outcomes but not the development of congestive heart failure (CHF). We hypothesized that the addition of Holter-based HRV parameters to an existing CHF clinical risk model would improve its ability to identify older adults at an increased risk of CHF in the Cardiovascular Health Study (CHS).
Methods: The Health ABC Heart Failure (Health ABC) score is a clinically based CHF prediction tool that has been validated in the CHS. Asymptomatic CHS participants with interpretable 24-hour baseline Holter recordings were included (N=1,401). Holter-based HRV measures and premature ventricular contraction (PVC) counts were compared between participants with (N=260) and without (N=1,141) incident CHF on follow up. Significantly different parameters between groups were added to the components of the Health ABC score using stepwise Cox regression.
Results: Participants who developed CHF were more likely to be older, male, and have left ventricular hypertrophy (LVH) and coronary artery disease (CAD). They were also more likely to have a higher body mass index, baseline heart rate, systolic blood pressure, fasting glucose and creatinine. The final prediction model included all components of the Health ABC score (age, creatinine, albumin, heart rate, systolic blood pressure, fasting glucose, LVH, smoking and CAD), ln (PVCs+1) (Hazard Ratio [HR]=1.12; 95% CI, 1.06-1.19; p<0.001) and the following HRV measures: abnormal heart rate turbulence onset (HR=1.52; 95% CI, 1.11-2.08; p=0.009), decreased short-term fractal scaling exponent (HR=0.27; 95% CI, 0.14-0.53; p<0.001), increased ln (very low frequency power) (HR=1.27; 95% CI, 1.01-1.60; p=0.039) and decreased coefficient of variance of NN intervals (HR=0.94; 95% CI, 0.90-0.99; p=0.01). The C-statistic for the final model was significantly improved over the Health ABC model alone (0.77 vs. 0.73, p=0.0002).
Conclusion: Abnormal HRV parameters were significant and independent predictors of incident CHF in asymptomatic, older adults. When combined with increased PVCs, these measures improved the predictive power of the Health ABC score in identifying CHS participants at an increased risk of developing CHF.
Author Disclosures: V.N. Patel: None. B. Pierce: None. R. Bodapati: None. D.L. Brown: None. D. Ives: None. P.K. Stein: None.
- © 2016 by American Heart Association, Inc.