title: Association Between Heart Rate at Rest and Incident Atrial Fibrillation (from the Copenhagen Electrocardiographic Study).
abstract: Heart rate (HR) at rest is a well-known marker of cardiovascular morbidity and mortality. Results on the association between HR and incident atrial fibrillation (AF) have, however, been conflicting. Using digital electrocardiograms from 281,451 primary care patients, we aimed to describe the association between HR at rest and the hazards of incident AF. Secondary end points were death from all causes and pacemaker implantation. Data on drug use, co-morbidity, and outcomes were collected from nationwide administrative health care registries. During a median follow-up time of 8.4 years, 15,666 subjects were observed to develop AF, of which 1,631 were lone AF. A HR at rest from 30 to 51 beats/min was associated with an adjusted hazard ratio of 1.16 (95% CI 1.06 to 1.27) for AF compared with the reference group (66 to 72 beats/min). From 72 beats/min and upward, the hazard ratio of AF increased in a dose-response manner, reaching an adjusted hazard ratio of 1.36 (95% CI 1.26 to 1.46) for HR between 95 and 120 beats/min. Both for low and high HR, the associations were accentuated for the outcome lone AF (adjusted hazard ratios of 1.48, 95% CI 1.19 to 1.84 and 1.84, 95% CI 1.47 to 2.30 for HR between 30 to 51 and 95 to 120 beats/min, respectively). For death from all causes, the hazard increased almost linearly with increasing HR. A HR at rest from 30 to 51 beats/min was associated with an adjusted hazard ratio of 1.80 (95% CI 1.46 to 2.21) for pacemaker implantation. In conclusion, a U-shaped association was found between HR at rest and incident AF, and this association was strongest for the outcome lone AF.
authors.affiliation: Laboratory for Molecular Cardiology, Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. Electronic address: m.wagnernielsen@gmail.com.
authors.forename: Morten W
authors.initials: MW
authors.lastname: Skov
authors.affiliation: Laboratory for Molecular Cardiology, Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Troels N
authors.initials: TN
authors.lastname: Bachmann
authors.affiliation: Laboratory for Molecular Cardiology, Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Peter V
authors.initials: PV
authors.lastname: Rasmussen
authors.affiliation: Laboratory for Molecular Cardiology, Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Morten S
authors.initials: MS
authors.lastname: Olesen
authors.affiliation: Copenhagen General Practitioners' Laboratory, Copenhagen, Denmark.
authors.forename: Adrian
authors.initials: A
authors.lastname: Pietersen
authors.affiliation: Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.
authors.forename: Claus
authors.initials: C
authors.lastname: Graff
authors.affiliation: Copenhagen General Practitioners' Laboratory, Copenhagen, Denmark.
authors.forename: Bent
authors.initials: B
authors.lastname: Lind
authors.affiliation: Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.
authors.forename: Johannes J
authors.initials: JJ
authors.lastname: Struijk
authors.affiliation: Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Lars
authors.initials: L
authors.lastname: Køber
authors.affiliation: Laboratory for Molecular Cardiology, Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Stig
authors.initials: S
authors.lastname: Haunsø
authors.affiliation: Laboratory for Molecular Cardiology, Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Jesper H
authors.initials: JH
authors.lastname: Svendsen
authors.affiliation: Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Gerds
authors.affiliation: Laboratory for Molecular Cardiology, Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Anders G
authors.initials: AG
authors.lastname: Holst
authors.affiliation: Laboratory for Molecular Cardiology, Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan; Department of Human Genetics, University of Michigan, Ann Arbor, Michigan.
authors.forename: Jonas B
authors.initials: JB
authors.lastname: Nielsen
mesh_terms: D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D003718:Denmark; D004562:Electrocardiography / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D012042:Registries; D012146:Rest; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors