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

Abstract

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.

Figure 1:

Risk of decline in functional status in tertiles of resting heart rate and standard deviation of normal-to-normal RR intervals (SDNN). All analyses are adjusted for country, age, sex, education, basic activities of daily living (ADL) and instrumental activities of daily living (IADL) scores at baseline, smoking, body mass index, history of hypertension, history of diabetes mellitus, history of claudication, history of myocardial infarction, history of stroke/transient ischemic attack, statin treatment, diuretics, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, β-blockers, calcium channel blockers, nitrates, acetylsalicylic acid and anticoagulants. Range of heart rate (no. of participants) in heart rate tertiles: low 34–60 beats/min (n = 1649); middle 61–70 beats/min (n = 1742); high 71–117 beats/min (n = 1651). Range of SDNN (no. of participants) in SDNN tertiles: low 1.70–13.30 ms (n = 1689); middle 13.40–26.50 ms (n = 1670); high 26.60–422.60 ms (n = 1683). Note: CI = confidence interval, OR = odds ratio.