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. 2024 May 23;110(12):831-837.
doi: 10.1136/heartjnl-2023-323681.

Reference ranges for ambulatory heart rate measurements in a middle-aged population

Anders Paul Persson  1   2 , Alexandra Måneheim  3   2 , Johan Economou Lundeberg  3   4 , Artur Fedorowski  5   6 , Jeff S Healey  7   8 , Johan Sundström  9   10 , Gunnar Engström  3 , Linda S B Johnson  3   7
Affiliations

Reference ranges for ambulatory heart rate measurements in a middle-aged population

Anders Paul Persson et al. Heart. .

Abstract

Background: Elevated heart rate (HR) predicts cardiovascular disease and mortality, but there are no established normal limits for ambulatory HR. We used data from the Swedish CArdioPulmonary Imaging Study to determine reference ranges for ambulatory HR in a middle-aged population. We also studied clinical correlates of ambulatory HR.

Methods: A 24-hour ECG was registered in 5809 atrial fibrillation-free individuals, aged 50-65 years. A healthy subset (n=3942) was used to establish reference values (excluding persons with beta-blockers, cardiovascular disease, hypertension, heart failure, anaemia, diabetes, sleep apnoea or chronic obstructive pulmonary disease).Minimum HR was defined as the lowest 1-minute HR. Reference ranges are reported as means±SDs and 2.5th-97.5th percentiles. Clinical correlates of ambulatory HR were analysed with multivariable linear regression.

Results: The average mean and minimum HRs were 73±9 and 48±7 beats per minute (bpm) in men and 76±8 and 51±7 bpm in women; the reference range for mean ambulatory HR was 57-90 bpm in men and 61-92 bpm in women. Average daytime and night-time HRs are also reported. Clinical correlates, including age, sex, height, body mass index, physical activity, smoking, alcohol intake, diabetes, hypertension, haemoglobin level, use of beta-blockers, estimated glomerular filtration rate, per cent of predicted forced expiratory volume in 1 s and coronary artery calcium score, explained <15% of the interindividual differences in HR.

Conclusion: Ambulatory HR varies widely in healthy middle-aged individuals, a finding with relevance for the management of patients with a perception of tachycardia. Differences in ambulatory HR between individuals are largely independent of common clinical correlates.

Keywords: Bradycardia; Electrocardiography; Epidemiology.

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Conflict of interest statement

Competing interests: AF has received speaker fees from Bristol-Myers Squibb, Finapres Medical Systems and Medtronic, and is a consultant to Argenx and Medtronic in the field of syncope, cardiovascular autonomic dysfunction and postural orthostatic tachycardia syndrome. LSBJ receives consulting fees from MEDICALgorithmics. JS is a shareholder of Symptoms Europe and Anagram kommunikation. JSH has research grants and speaker fees from BMS/Pfizer, Boehringer-Ingelheim, Boston Scientific, Novartis, Medtronic and Servier.

Figures

Figure 1
Figure 1
Derivation of study population. 24hECG, 24-hour ECG; SCAPIS, Swedish CArdioPulmonary Imaging Study.
Figure 2
Figure 2
Heart rates in the healthy reference sample, histogram and sex-specific cumulative distribution curves.
See this image and copyright information in PMC

References

    1. Aune D, Sen A, ó’Hartaigh B, et al. . Resting heart rate and the risk of cardiovascular disease, total cancer, and all-cause mortality - a systematic review and dose-response meta-analysis of prospective studies. Nutr Metab Cardiovasc Dis 2017;27:504–17. 10.1016/j.numecd.2017.04.004 - DOI - PubMed
    1. Dyer AR, Persky V, Stamler J, et al. . Heart rate as a prognostic factor for coronary heart disease and mortality: findings in three chicago epidemiologic studies. Am J Epidemiol 1980;112:736–49. 10.1093/oxfordjournals.aje.a113046 - DOI - PubMed
    1. Kannel WB, Kannel C, Paffenbarger RS, et al. . Heart rate and cardiovascular mortality: the framingham study. Am Heart J 1987;113:1489–94. 10.1016/0002-8703(87)90666-1 - DOI - PubMed
    1. Greenland P, Daviglus ML, Dyer AR, et al. . Resting heart rate is a risk factor for cardiovascular and Noncardiovascular mortality: the chicago heart association detection project in industry. Am J Epidemiol 1999;149:853–62. 10.1093/oxfordjournals.aje.a009901 - DOI - PubMed
    1. Kolloch R, Legler UF, Champion A, et al. . Impact of resting heart rate on outcomes in hypertensive patients with coronary artery disease findings from the International verapamil-SR/Trandolapril study (INVEST). Eur Heart J 2008;29:1327–34. 10.1093/eurheartj/ehn123 - DOI - PMC - PubMed