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Original Research

Speed of Heart Rate Recovery in Response to Orthostatic Challenge: A Strong Risk Marker of Mortality

Cathal McCrory, Lisa Berkman, Hugh Nolan, Neil O'Leary, Margaret Foley, Rose Anne Kenny
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https://doi.org/10.1161/CIRCRESAHA.116.308577
Circulation Research. 2016;CIRCRESAHA.116.308577
Originally published June 21, 2016
Cathal McCrory
The Irish Longitudinal Study on Aging, Trinity College Dublin
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  • For correspondence: mccrorc@tcd.ie
Lisa Berkman
Center for Population and Development Studies, Harvard School of Public Health
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Hugh Nolan
The Irish Longitudinal Study on Aging, Trinity College Dublin
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Neil O'Leary
The Irish Longitudinal Study on Aging, Trinity College Dublin
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Margaret Foley
The Irish Longitudinal Study on Aging, Trinity College Dublin
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Rose Anne Kenny
The Irish Longitudinal Study on Aging, Trinity College Dublin
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Abstract

Rationale: Speed of Heart Rate Recovery (HRR) may serve as an important biomarker of aging and mortality.

Objective: To examine whether the speed of HRR following an orthostatic maneuver (i.e. active stand from supine position) predicts mortality.

Methods and Results: A longitudinal cohort study involving a nationally representative sample of community dwelling older persons aged 50 years+. 4475 participants completed an active stand at baseline as part of a detailed clinic-based cardiovascular assessment. Beat-to-beat heart rate and blood pressure responses to standing were measured over a two-minute window using a finometer and binned in 10-second intervals. We modeled HRR to the stand by age group, cardiovascular disease burden, and mortality status using a random effects model. Mortality status over a mean follow-up duration of 4 years served as the primary end-point (n=138). Speed of HRR in the immediate 20 seconds after standing was a strong predictor of mortality. A one beat per minute slower between 10 and 20 seconds after standing increased the hazard of mortality by 6% controlling for established risk factors. A clear dose-response relationship was evident. 69 participants in the slowest HRR quartile died over the observation period compared with 14 participants in the fastest HRR quartile. Participants in the slowest recovery quartile were 2.3 times more likely to die compared with those in the fastest recovery quartile.

Conclusions: Speed of orthostatic HRR predicts mortality and may aid clinical decision making. Attenuated orthostatic HRR may reflect dysregulation of the parasympathetic branch of the autonomic nervous system.

  • heart rate recovery
  • mortality
  • autonomic nervous system
  • epidemiology
  • Received February 19, 2016.
  • Revision received June 17, 2016.
  • Accepted June 21, 2016.
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    Speed of Heart Rate Recovery in Response to Orthostatic Challenge: A Strong Risk Marker of Mortality
    Cathal McCrory, Lisa Berkman, Hugh Nolan, Neil O'Leary, Margaret Foley and Rose Anne Kenny
    Circulation Research. 2016;CIRCRESAHA.116.308577, originally published June 21, 2016
    https://doi.org/10.1161/CIRCRESAHA.116.308577

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    Speed of Heart Rate Recovery in Response to Orthostatic Challenge: A Strong Risk Marker of Mortality
    Cathal McCrory, Lisa Berkman, Hugh Nolan, Neil O'Leary, Margaret Foley and Rose Anne Kenny
    Circulation Research. 2016;CIRCRESAHA.116.308577, originally published June 21, 2016
    https://doi.org/10.1161/CIRCRESAHA.116.308577
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