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. 2023 May 19;25(5):euad062.
doi: 10.1093/europace/euad062.

Dynamic changes in nocturnal heart rate predict short-term cardiovascular events in patients using the wearable cardioverter-defibrillator: from the WEARIT-France cohort study

Rodrigue Garcia  1   2 , Peder Emil Warming  3 , Kumar Narayanan  4   5 , Pascal Defaye  6 , Laurence Guedon-Moreau  7 , Hugues Blangy  8 , Olivier Piot  9 , Christophe Leclercq  10 , Eloi Marijon  11   5 ; WEARIT-France Investigators
Collaborators, Affiliations

Dynamic changes in nocturnal heart rate predict short-term cardiovascular events in patients using the wearable cardioverter-defibrillator: from the WEARIT-France cohort study

Rodrigue Garcia et al. Europace. .

Abstract

Aims: While elevated resting heart rate measured at a single point of time has been associated with cardiovascular outcomes, utility of continuous monitoring of nocturnal heart rate (NHR) has never been evaluated. We hypothesized that dynamic NHR changes may predict, at short term, impending cardiovascular events in patients equipped with a wearable cardioverter-defibrillator (WCD).

Methods and results: The WEARIT-France prospective cohort study enrolled heart failure patients with WCD between 2014 and 2018. Night-time was defined as midnight to 7 a.m. NHR initial trajectories were classified into four categories based on mean NHR in the first week (High/Low) and NHR evolution over the second week (Up/Down) of WCD use. The primary endpoint was a composite of cardiovascular death and heart failure hospitalization. A total of 1013 [61 (interquartile range, IQR 53-68) years, 16% women, left ventricular ejection fraction 26% (IQR 22-30)] were included. During a median WCD wear duration of 68 (IQR 44-90) days, 58 patients (6%) experienced 69 events. After considering potential confounders, High-Up NHR trajectory was significantly associated with the primary endpoint compared to Low-Down [adjusted hazard ratio (HR) 6.08, 95% confidence interval (CI) 2.56-14.45, P < 0.001]. Additionally, a rise of >5 bpm in weekly average NHR from the preceding week was associated with 2.5 higher composite event risk (HR 2.51, 95% CI 1.22-5.18, P = 0.012) as well as total mortality (HR 11.21, 95% CI 3.55-35.37, P < 0.001) and cardiovascular hospitalization (HR 2.70, 95% CI 1.51-4.82, P < 0.001).

Conclusion: Dynamic monitoring of NHR may allow timely identification of impending cardiovascular events, with the potential for 'pre-emptive' action.

Registration number: Clinical Trials.gov Identifier: NCT03319160.

Keywords: Heart failure; Heart rate; Pre-emptive action; Remote monitoring; Wearable cardioverter-defibrillator.

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Conflict of interest statement

Conflict of interest: E.M. is consultant for ZOLL, Boston, Medtronic and received unrestricted grants from industrial partners (Medtronic, Abbott, Boston Scientific, Microport, Biotronik and ZOLL). R.G. have been compensated by ZOLL for giving presentations. The remaining authors have nothing to disclose.

Figures

Graphical Abstract
Graphical Abstract
Figure 1
Figure 1
Primary endpoint cumulative incidence according to initial NHR trajectories. NHR, nocturnal heart rate.
Figure 2
Figure 2
NHR dynamics among patients with and without primary event. NHR, nocturnal heart rate.
Figure 3
Figure 3
Association between ΔNHR and primary endpoint occurrence. NHR, nocturnal heart rate.
See this image and copyright information in PMC

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