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Review
. 2017 May 9;6(5):e005505.
doi: 10.1161/JAHA.117.005505.

Heart Rate Recovery and Risk of Cardiovascular Events and All-Cause Mortality: A Meta-Analysis of Prospective Cohort Studies

Shanhu Qiu  1 , Xue Cai  1 , Zilin Sun  2 , Ling Li  1 , Martina Zuegel  3 , Juergen Michael Steinacker  3 , Uwe Schumann  3
Affiliations
Review

Heart Rate Recovery and Risk of Cardiovascular Events and All-Cause Mortality: A Meta-Analysis of Prospective Cohort Studies

Shanhu Qiu et al. J Am Heart Assoc. .

Abstract

Background: Heart rate recovery (HRR) is a noninvasive assessment of autonomic dysfunction and has been implicated with risk of cardiovascular events and all-cause mortality. However, evidence has not been systematically assessed. We performed a meta-analysis of prospective cohort studies to quantify these associations in the general population.

Methods and results: A literature search using 3 databases up to August 2016 was conducted for studies that reported hazard ratios with 95% CIs for the association between baseline HRR and outcomes of interest. The overall hazard ratios were calculated using a random-effects model. There were 9 eligible studies in total, with 5 for cardiovascular events enrolling 1061 cases from 34 267 participants, and 9 for all-cause mortality enrolling 2082 cases from 41 600 participants. The pooled hazard ratios associated with attenuated HRR versus fast HRR that served as the referent were 1.69 (95% CI 1.05-2.71) for cardiovascular events and 1.68 (95% CI 1.51-1.88) for all-cause mortality. For every 10 beats per minute decrements in HRR, the hazard ratios were 1.13 (95% CI 1.05-1.21) and 1.09 (95% CI 1.01-1.19), respectively. Further analyses suggested that the associations observed between attenuated HRR and risk of fatal cardiovascular events and all-cause mortality were independent of traditional metabolic factors for cardiovascular disease (all P<0.05).

Conclusions: Attenuated HRR is associated with increased risk of cardiovascular events and all-cause mortality, which supports the recommendation of recording HRR for risk assessment in clinical practice as a routine.

Keywords: cardiovascular events; heart rate recovery; mortality.

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Figures

Figure 1
Figure 1
Flow diagram of literature search. *The study by Wandell et al21 had results stratified by sex, and were treated as separate studies.
Figure 2
Figure 2
Meta‐analysis of cardiovascular events and all‐cause mortality for attenuated vs fast heart rate recovery. HR indicates hazard ratio. *The study by Park et al10 reported separate data on ischemia and silent myocardial ischemia, which were combined together using a fixed‐effects model.
Figure 3
Figure 3
Meta‐analysis of cardiovascular events and all‐cause mortality for every 10‐beats‐per‐minute decrement in heart rate recovery. HR indicates hazard ratio.
See this image and copyright information in PMC

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