Resting heart rate, heart rate variability and functional decline in old age.
BACKGROUND
Heart rate and heart rate variability, markers of cardiac autonomic function, have been linked with cardiovascular disease. We investigated whether heart rate and heart rate variability are associated with functional status in older adults, independent of cardiovascular disease.


METHODS
We obtained data from the Prospective Study of Pravastatin in the Elderly at Risk (PROSPER). A total of 5042 participants were included in the present study, and mean follow-up was 3.2 years. Heart rate and heart rate variability were derived from baseline 10-second electrocardiograms. Heart rate variability was defined as the standard deviation of normal-to-normal RR intervals (SDNN). Functional status in basic (ADL) and instrumental (IADL) activities of daily living was measured using Barthel and Lawton scales, at baseline and during follow-up.


RESULTS
The mean age of the study population was 75.3 years. At baseline, higher heart rate was associated with worse ADL and IADL, and lower SDNN was related to worse IADL (all p values < 0.05). Participants in the highest tertile of heart rate (range 71-117 beats/min) had a 1.79-fold (95% confidence interval [CI] 1.45-2.22) and 1.35-fold (95% CI 1.12-1.63) higher risk of decline in ADL and IADL, respectively (p for trend < 0.001 and 0.001, respectively). Participants in the lowest tertile of SDNN (range 1.70-13.30 ms) had 1.21-fold (95% CI 1.00-1.46) and 1.25-fold (95% CI 1.05-1.48) higher risk of decline in ADL and IADL, respectively (both p for trends < 0.05). All associations were independent of sex, medications, cardiovascular risk factors and comorbidities.


CONCLUSIONS
Higher resting heart rate and lower heart rate variability were associated with worse functional status and with higher risk of future functional decline in older adults, independent of cardiovascular disease. This study provides insight into the role of cardiac autonomic function in the development of functional decline.
Department of Gerontology and Geriatrics (Ogliari, Mahinrad, Mooijaart, Westendorp, de Craen, Sabayan), Leiden University Medical Center, Leiden, the Netherlands; Department of Clinical Sciences and Community Health (Ogliari), University of Milan, Milan, Italy; Academic Section of Geriatric Medicine (Stott), Faculty of Medicine, University of Glasgow, Glasgow, United Kingdom; Department of Cardiology (Jukema), Leiden University Medical Center, Leiden, the Netherlands; Institute for Evidence-Based Medicine in Old Age (Mooijaart), Leiden, the Netherlands; Institute of Cardiovascular and Medical Sciences (Macfarlane, Clark), University of Glasgow, Glasgow, United Kingdom; Department of Epidemiology and Public Health (Kearney), University College Cork, Cork, Ireland; Department of Public Health (Westendorp), University of Copenhagen, Copenhagen, Denmark; Department of Radiology (Sabayan), Leiden University Medical Center, Leiden, the Netherlands.
Giulia
G
Ogliari
Department of Gerontology and Geriatrics (Ogliari, Mahinrad, Mooijaart, Westendorp, de Craen, Sabayan), Leiden University Medical Center, Leiden, the Netherlands; Department of Clinical Sciences and Community Health (Ogliari), University of Milan, Milan, Italy; Academic Section of Geriatric Medicine (Stott), Faculty of Medicine, University of Glasgow, Glasgow, United Kingdom; Department of Cardiology (Jukema), Leiden University Medical Center, Leiden, the Netherlands; Institute for Evidence-Based Medicine in Old Age (Mooijaart), Leiden, the Netherlands; Institute of Cardiovascular and Medical Sciences (Macfarlane, Clark), University of Glasgow, Glasgow, United Kingdom; Department of Epidemiology and Public Health (Kearney), University College Cork, Cork, Ireland; Department of Public Health (Westendorp), University of Copenhagen, Copenhagen, Denmark; Department of Radiology (Sabayan), Leiden University Medical Center, Leiden, the Netherlands.
Simin
S
Mahinrad
Department of Gerontology and Geriatrics (Ogliari, Mahinrad, Mooijaart, Westendorp, de Craen, Sabayan), Leiden University Medical Center, Leiden, the Netherlands; Department of Clinical Sciences and Community Health (Ogliari), University of Milan, Milan, Italy; Academic Section of Geriatric Medicine (Stott), Faculty of Medicine, University of Glasgow, Glasgow, United Kingdom; Department of Cardiology (Jukema), Leiden University Medical Center, Leiden, the Netherlands; Institute for Evidence-Based Medicine in Old Age (Mooijaart), Leiden, the Netherlands; Institute of Cardiovascular and Medical Sciences (Macfarlane, Clark), University of Glasgow, Glasgow, United Kingdom; Department of Epidemiology and Public Health (Kearney), University College Cork, Cork, Ireland; Department of Public Health (Westendorp), University of Copenhagen, Copenhagen, Denmark; Department of Radiology (Sabayan), Leiden University Medical Center, Leiden, the Netherlands.
David J
DJ
Stott
Department of Gerontology and Geriatrics (Ogliari, Mahinrad, Mooijaart, Westendorp, de Craen, Sabayan), Leiden University Medical Center, Leiden, the Netherlands; Department of Clinical Sciences and Community Health (Ogliari), University of Milan, Milan, Italy; Academic Section of Geriatric Medicine (Stott), Faculty of Medicine, University of Glasgow, Glasgow, United Kingdom; Department of Cardiology (Jukema), Leiden University Medical Center, Leiden, the Netherlands; Institute for Evidence-Based Medicine in Old Age (Mooijaart), Leiden, the Netherlands; Institute of Cardiovascular and Medical Sciences (Macfarlane, Clark), University of Glasgow, Glasgow, United Kingdom; Department of Epidemiology and Public Health (Kearney), University College Cork, Cork, Ireland; Department of Public Health (Westendorp), University of Copenhagen, Copenhagen, Denmark; Department of Radiology (Sabayan), Leiden University Medical Center, Leiden, the Netherlands.
J Wouter
JW
Jukema
Department of Gerontology and Geriatrics (Ogliari, Mahinrad, Mooijaart, Westendorp, de Craen, Sabayan), Leiden University Medical Center, Leiden, the Netherlands; Department of Clinical Sciences and Community Health (Ogliari), University of Milan, Milan, Italy; Academic Section of Geriatric Medicine (Stott), Faculty of Medicine, University of Glasgow, Glasgow, United Kingdom; Department of Cardiology (Jukema), Leiden University Medical Center, Leiden, the Netherlands; Institute for Evidence-Based Medicine in Old Age (Mooijaart), Leiden, the Netherlands; Institute of Cardiovascular and Medical Sciences (Macfarlane, Clark), University of Glasgow, Glasgow, United Kingdom; Department of Epidemiology and Public Health (Kearney), University College Cork, Cork, Ireland; Department of Public Health (Westendorp), University of Copenhagen, Copenhagen, Denmark; Department of Radiology (Sabayan), Leiden University Medical Center, Leiden, the Netherlands.
Simon P
SP
Mooijaart
Department of Gerontology and Geriatrics (Ogliari, Mahinrad, Mooijaart, Westendorp, de Craen, Sabayan), Leiden University Medical Center, Leiden, the Netherlands; Department of Clinical Sciences and Community Health (Ogliari), University of Milan, Milan, Italy; Academic Section of Geriatric Medicine (Stott), Faculty of Medicine, University of Glasgow, Glasgow, United Kingdom; Department of Cardiology (Jukema), Leiden University Medical Center, Leiden, the Netherlands; Institute for Evidence-Based Medicine in Old Age (Mooijaart), Leiden, the Netherlands; Institute of Cardiovascular and Medical Sciences (Macfarlane, Clark), University of Glasgow, Glasgow, United Kingdom; Department of Epidemiology and Public Health (Kearney), University College Cork, Cork, Ireland; Department of Public Health (Westendorp), University of Copenhagen, Copenhagen, Denmark; Department of Radiology (Sabayan), Leiden University Medical Center, Leiden, the Netherlands.
Peter W
PW
Macfarlane
Department of Gerontology and Geriatrics (Ogliari, Mahinrad, Mooijaart, Westendorp, de Craen, Sabayan), Leiden University Medical Center, Leiden, the Netherlands; Department of Clinical Sciences and Community Health (Ogliari), University of Milan, Milan, Italy; Academic Section of Geriatric Medicine (Stott), Faculty of Medicine, University of Glasgow, Glasgow, United Kingdom; Department of Cardiology (Jukema), Leiden University Medical Center, Leiden, the Netherlands; Institute for Evidence-Based Medicine in Old Age (Mooijaart), Leiden, the Netherlands; Institute of Cardiovascular and Medical Sciences (Macfarlane, Clark), University of Glasgow, Glasgow, United Kingdom; Department of Epidemiology and Public Health (Kearney), University College Cork, Cork, Ireland; Department of Public Health (Westendorp), University of Copenhagen, Copenhagen, Denmark; Department of Radiology (Sabayan), Leiden University Medical Center, Leiden, the Netherlands.
Elaine N
EN
Clark
Department of Gerontology and Geriatrics (Ogliari, Mahinrad, Mooijaart, Westendorp, de Craen, Sabayan), Leiden University Medical Center, Leiden, the Netherlands; Department of Clinical Sciences and Community Health (Ogliari), University of Milan, Milan, Italy; Academic Section of Geriatric Medicine (Stott), Faculty of Medicine, University of Glasgow, Glasgow, United Kingdom; Department of Cardiology (Jukema), Leiden University Medical Center, Leiden, the Netherlands; Institute for Evidence-Based Medicine in Old Age (Mooijaart), Leiden, the Netherlands; Institute of Cardiovascular and Medical Sciences (Macfarlane, Clark), University of Glasgow, Glasgow, United Kingdom; Department of Epidemiology and Public Health (Kearney), University College Cork, Cork, Ireland; Department of Public Health (Westendorp), University of Copenhagen, Copenhagen, Denmark; Department of Radiology (Sabayan), Leiden University Medical Center, Leiden, the Netherlands.
Patricia M
PM
Kearney
Department of Gerontology and Geriatrics (Ogliari, Mahinrad, Mooijaart, Westendorp, de Craen, Sabayan), Leiden University Medical Center, Leiden, the Netherlands; Department of Clinical Sciences and Community Health (Ogliari), University of Milan, Milan, Italy; Academic Section of Geriatric Medicine (Stott), Faculty of Medicine, University of Glasgow, Glasgow, United Kingdom; Department of Cardiology (Jukema), Leiden University Medical Center, Leiden, the Netherlands; Institute for Evidence-Based Medicine in Old Age (Mooijaart), Leiden, the Netherlands; Institute of Cardiovascular and Medical Sciences (Macfarlane, Clark), University of Glasgow, Glasgow, United Kingdom; Department of Epidemiology and Public Health (Kearney), University College Cork, Cork, Ireland; Department of Public Health (Westendorp), University of Copenhagen, Copenhagen, Denmark; Department of Radiology (Sabayan), Leiden University Medical Center, Leiden, the Netherlands.
Rudi G J
RGJ
Westendorp
Department of Gerontology and Geriatrics (Ogliari, Mahinrad, Mooijaart, Westendorp, de Craen, Sabayan), Leiden University Medical Center, Leiden, the Netherlands; Department of Clinical Sciences and Community Health (Ogliari), University of Milan, Milan, Italy; Academic Section of Geriatric Medicine (Stott), Faculty of Medicine, University of Glasgow, Glasgow, United Kingdom; Department of Cardiology (Jukema), Leiden University Medical Center, Leiden, the Netherlands; Institute for Evidence-Based Medicine in Old Age (Mooijaart), Leiden, the Netherlands; Institute of Cardiovascular and Medical Sciences (Macfarlane, Clark), University of Glasgow, Glasgow, United Kingdom; Department of Epidemiology and Public Health (Kearney), University College Cork, Cork, Ireland; Department of Public Health (Westendorp), University of Copenhagen, Copenhagen, Denmark; Department of Radiology (Sabayan), Leiden University Medical Center, Leiden, the Netherlands.
Anton J M
AJM
de Craen
Department of Gerontology and Geriatrics (Ogliari, Mahinrad, Mooijaart, Westendorp, de Craen, Sabayan), Leiden University Medical Center, Leiden, the Netherlands; Department of Clinical Sciences and Community Health (Ogliari), University of Milan, Milan, Italy; Academic Section of Geriatric Medicine (Stott), Faculty of Medicine, University of Glasgow, Glasgow, United Kingdom; Department of Cardiology (Jukema), Leiden University Medical Center, Leiden, the Netherlands; Institute for Evidence-Based Medicine in Old Age (Mooijaart), Leiden, the Netherlands; Institute of Cardiovascular and Medical Sciences (Macfarlane, Clark), University of Glasgow, Glasgow, United Kingdom; Department of Epidemiology and Public Health (Kearney), University College Cork, Cork, Ireland; Department of Public Health (Westendorp), University of Copenhagen, Copenhagen, Denmark; Department of Radiology (Sabayan), Leiden University Medical Center, Leiden, the Netherlands b.sabayan@lumc.nl.
Behnam
B
Sabayan
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000503:physiopathology*; D003430:Cross-Sectional Studies; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D007494:Ireland; D008137:Longitudinal Studies; D008297:Male; D009426:Netherlands; D011446:Prospective Studies; D012307:Risk Factors; D012606:Scotland