title: Ambulatory heart rate range predicts mode-specific mortality and hospitalisation in chronic heart failure.
abstract: OBJECTIVE
  We aimed to define the prognostic value of the heart rate range during a 24 h period in patients with chronic heart failure (CHF).
  
  
  METHODS
  Prospective observational cohort study of 791 patients with CHF associated with left ventricular systolic dysfunction. Mode-specific mortality and hospitalisation were linked with ambulatory heart rate range (AHRR; calculated as maximum minus minimum heart rate using 24 h Holter monitor data, including paced and non-sinus complexes) in univariate and multivariate analyses. Findings were then corroborated in a validation cohort of 408 patients with CHF with preserved or reduced left ventricular ejection fraction.
  
  
  RESULTS
  After a mean 4.1 years of follow-up, increasing AHRR was associated with reduced risk of all-cause, sudden, non-cardiovascular and progressive heart failure death in univariate analyses. After accounting for characteristics that differed between groups above and below median AHRR using multivariate analysis, AHRR remained strongly associated with all-cause mortality (HR 0.991/bpm increase in AHRR (95% CI 0.999 to 0.982); p=0.046). AHRR was not associated with the risk of any non-elective hospitalisation, but was associated with heart-failure-related hospitalisation. AHRR was modestly associated with the SD of normal-to-normal beats (R(2)=0.2; p<0.001) and with peak exercise-test heart rate (R(2)=0.33; p<0.001). Analysis of the validation cohort revealed AHRR to be associated with all-cause and mode-specific death as described in the derivation cohort.
  
  
  CONCLUSIONS
  AHRR is a novel and readily available prognosticator in patients with CHF, which may reflect autonomic tone and exercise capacity.
authors.affiliation: Multidisciplinary Cardiovascular Research Centre, LIGHT Laboratories, The University of Leeds, Leeds, UK.
authors.forename: Richard M
authors.initials: RM
authors.lastname: Cubbon
authors.affiliation: Multidisciplinary Cardiovascular Research Centre, LIGHT Laboratories, The University of Leeds, Leeds, UK.
authors.forename: Naomi
authors.initials: N
authors.lastname: Ruff
authors.affiliation: Medical Physics and Clinical Engineering Department, Royal Liverpool University Hospital, Liverpool, UK Physics Department, University of Liverpool, Liverpool, UK.
authors.forename: David
authors.initials: D
authors.lastname: Groves
authors.affiliation: Medical Physics and Clinical Engineering Department, Royal Liverpool University Hospital, Liverpool, UK Physics Department, University of Liverpool, Liverpool, UK.
authors.forename: Antonio
authors.initials: A
authors.lastname: Eleuteri
authors.affiliation: Medical Physics and Clinical Engineering Department, Royal Liverpool University Hospital, Liverpool, UK Physics Department, University of Liverpool, Liverpool, UK.
authors.forename: Christine
authors.initials: C
authors.lastname: Denby
authors.affiliation: Multidisciplinary Cardiovascular Research Centre, LIGHT Laboratories, The University of Leeds, Leeds, UK.
authors.forename: Lorraine
authors.initials: L
authors.lastname: Kearney
authors.affiliation: Multidisciplinary Cardiovascular Research Centre, LIGHT Laboratories, The University of Leeds, Leeds, UK.
authors.forename: Noman
authors.initials: N
authors.lastname: Ali
authors.affiliation: Multidisciplinary Cardiovascular Research Centre, LIGHT Laboratories, The University of Leeds, Leeds, UK.
authors.forename: Andrew M N
authors.initials: AM
authors.lastname: Walker
authors.affiliation: Multidisciplinary Cardiovascular Research Centre, LIGHT Laboratories, The University of Leeds, Leeds, UK.
authors.forename: Haqeel
authors.initials: H
authors.lastname: Jamil
authors.affiliation: Multidisciplinary Cardiovascular Research Centre, LIGHT Laboratories, The University of Leeds, Leeds, UK.
authors.forename: John
authors.initials: J
authors.lastname: Gierula
authors.affiliation: Multidisciplinary Cardiovascular Research Centre, LIGHT Laboratories, The University of Leeds, Leeds, UK.
authors.forename: Chris P
authors.initials: CP
authors.lastname: Gale
authors.affiliation: Cardiology Department, Pinderfields General Hospital, Mid Yorkshire Hospitals NHS Trust, Wakefield, UK.
authors.forename: Phillip D
authors.initials: PD
authors.lastname: Batin
authors.affiliation: University Hospital of North Staffordshire, Stoke-on-Trent, UK.
authors.forename: James
authors.initials: J
authors.lastname: Nolan
authors.affiliation: BHF Centre of Excellence, King's College London, London, UK.
authors.forename: Ajay M
authors.initials: AM
authors.lastname: Shah
authors.affiliation: BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.
authors.forename: Keith A A
authors.initials: KA
authors.lastname: Fox
authors.affiliation: Cardiology Department, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Sapsford
authors.affiliation: Multidisciplinary Cardiovascular Research Centre, LIGHT Laboratories, The University of Leeds, Leeds, UK.
authors.forename: Klaus K
authors.initials: KK
authors.lastname: Witte
authors.affiliation: Multidisciplinary Cardiovascular Research Centre, LIGHT Laboratories, The University of Leeds, Leeds, UK.
authors.forename: Mark T
authors.initials: MT
authors.lastname: Kearney
mesh_terms: D000368:Aged; D002908:Chronic Disease; D015331:Cohort Studies; D015716:Electrocardiography, Ambulatory; D005080:Exercise Test; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000503:physiopathology*; D006339:Heart Rate; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D011446:Prospective Studies; D018487:Ventricular Dysfunction, Left / Q000401:mortality / Q000503:physiopathology*