Abstract 20385: Cardiac Autonomic Dysfunction and Incidence of Heart Failure: The Atherosclerosis Risk in Communities Study
Introduction: Interventions to modify autonomic tone have been sought as a way to improve outcomes in heart failure (HF) patients. Low heart rate variability (HRV) measures signify autonomic dysfunction. However, the role of autonomic dysfunction in the etiology of heart failure (HF) remains unclear.
Hypothesis: Lower HRV will be associated with a higher risk of HF.
Methods: We analyzed data on 9,088 participants to the Atherosclerosis Risk in Communities (ARIC) Study. HRV measures derived from 2-minute rhythm ECG at baseline visit (1987-89), included standard deviation of RR intervals (SDNN) and frequency domain measures. Incident HF was ascertained through hospital discharge or death certificate codes thorough 2010.
Results: During a median follow-up of 21.6 years, 1,345 (15%) participants developed HF (incidence rate 7.7/1,000 person-years). Low HRV measures were associated with a higher incidence of HF. For instance, for each unit lower standard deviation of log (SDNN) HF risk was 55% higher (Hazards Ratio 1.55 (95% CI: 1.45, 1.65)), independent of age, gender, race, and heart rate. After additional adjustment for education level, study center, smoking status, alcohol intake, physical activity, body mass index, diabetes, systolic BP, diastolic BP, LDL cholesterol, HDL cholesterol, prevalent CHD, beta blockers use, and estimated GFR, the risk was 21% higher (HR 1.21 (95% CI 1.13, 1.29)) per standard deviation lower log (SDNN). The relationship was not different by race, gender, or prevalent CHD. Lower HRV measures continued to be associated with higher risk of heart failure among those without prevalent or incident CHD as well in models adjusting for incident CHD as time varying covariate.
Conclusions: Cardiac autonomic dysfunction, as indicated by a low HRV, is associated with an increased HF incidence over 20 years of follow up independent of potential confounders. Whether interventions to improve autonomic function may prevent heart failure need study.
Author Disclosures: S.K. Agarwal: None. J. Echouffo-Tcheugui: None. C. Ndumele: None. W. Rosamond: None. G. Heiss: None. J. Coresh: None.
- © 2016 by American Heart Association, Inc.