Predicting 7-day survival using heart rate variability in hospice patients with non-lung cancers.
BACKGROUND
A simple and accurate survival prediction tool can facilitate decision making processes for hospice patients with advanced cancers. The objectives of this study were to explore the association of cardiac autonomic functions and survival in patients with advanced cancer and to evaluate the prognostic value of heart rate variability (HRV) in 7-day survival prediction.


METHODS
A prospective study was conducted on 138 patients with advanced cancer recruited from the hospice ward of a regional hospital in southern Taiwan. Information on functional status and symptom burden of the patients was recorded. Frequency-domain HRV was obtained for the evaluation of cardiac autonomic functions at admission. The end point of the study was defined as the survival status at day 7 after admission to the hospice ward. Multivariate logistic regression analyses were performed to evaluate the independent associations between HRV indices and survival of 7 days or less.


RESULTS
The median survival time of the patients was 20 days (95% CI, 17-28 days). Results from the multivariate logistic regression analysis indicated that the natural logarithm-transformed high-frequency power (lnHFP) of a value less than 2 (OR = 3.8, p = 0.008) and ECOG performance status of 3 or 4 (OR = 3.4, p = 0.023) were significantly associated with a higher risk of survival of 7 days or less. Receiver operating characteristic (ROC) curve analysis revealed that the area under the curve was 0.71 (95% CI, 0.61-0.81).


CONCLUSIONS
In hospice patients with non-lung cancers, an lnHPF value below 2 at hospice admission was significantly associated with survival of 7 days or less. HRV might be used as a non-invasive and objective tool to facilitate medical decision making by improving the accuracy in survival prediction.
Department of Family Medicine, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan.
Jui-Kun
JK
Chiang
Terry B J
TB
Kuo
Chin-Hua
CH
Fu
Malcolm
M
Koo
D000368:Aged; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006738:Hospices / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008175:Lung Neoplasms / Q000503:physiopathology; D008297:Male; D015999:Multivariate Analysis; D009369:Neoplasms / Q000453:epidemiology / Q000503:physiopathology*; D012372:ROC Curve; D016019:Survival Analysis; D013624:Taiwan / Q000453:epidemiology; D013997:Time Factors