title: Association of Holter-Derived Heart Rate Variability Parameters With the Development of Congestive Heart Failure in the Cardiovascular Health Study.
abstract: This study sought to determine whether Holter-based parameters of heart rate variability (HRV) are independently associated with incident heart failure among older adults in the CHS (Cardiovascular Health Study) as evidenced by an improvement in the predictive power of the Health Aging and Body Composition Heart Failure (Health ABC) score.
  
  
  
  Abnormal HRV, a marker of autonomic dysfunction, has been associated with multiple adverse cardiovascular outcomes but not the development of congestive heart failure (CHF).
  
  
  
  Asymptomatic CHS participants with interpretable 24-h baseline Holter recordings were included (n = 1,401). HRV measures and premature ventricular contraction (PVC) counts were compared between participants with (n = 260) and without (n = 1,141) incident CHF on follow-up. Significantly different parameters between groups were added to the components of the Health ABC score, a validated CHF prediction tool, using stepwise Cox regression.
  
  
  
  The final model included components of the Health ABC score, In PVC counts (adjusted hazard ratio [aHR]: 1.12; 95% confidence interval [CI]: 1.07 to 1.19; p < 0.001) and the following HRV measures: abnormal heart rate turbulence onset (aHR: 1.52; 95% CI: 1.11 to 2.08; p = 0.009), short-term fractal scaling exponent (aHR: 0.27; 95% CI: 0.14 to 0.53; p < 0.001), in very low frequency power (aHR: 1.28; 95% CI: 1.02 to 1.60; p = 0.037), and coefficient of variance of N-N intervals (aHR: 0.94; 95% CI: 0.90 to 0.99; p = 0.009). The C-statistic for the final model was significantly improved over the Health ABC model alone (0.77 vs. 0.73; p = 0.0002).
  
  
  
  Abnormal HRV parameters were significantly and independently associated with incident CHF in asymptomatic, older adults. When combined with increased PVCs, HRV improved the predictive power of the Health ABC score.
authors.affiliation: Division of Hospital Medicine, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Vaiibhav N
authors.initials: VN
authors.lastname: Patel
authors.affiliation: Division of Hospital Medicine, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Brian R
authors.initials: BR
authors.lastname: Pierce
authors.affiliation: Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Rohan K
authors.initials: RK
authors.lastname: Bodapati
authors.affiliation: Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: David L
authors.initials: DL
authors.lastname: Brown
authors.affiliation: Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Diane G
authors.initials: DG
authors.lastname: Ives
authors.affiliation: Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri. Electronic address: pstein@dom.wustl.edu.
authors.forename: Phyllis K
authors.initials: PK
authors.lastname: Stein
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000150:complications* / Q000503:physiopathology; D002940:Circadian Rhythm; D015716:Electrocardiography, Ambulatory; D005260:Female; D006333:Heart Failure / Q000209:etiology*; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000378:metabolism; D010446:Peptide Fragments / Q000378:metabolism; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D018879:Ventricular Premature Complexes / Q000150:complications / Q000503:physiopathology
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: heart failure; heart rate variability; risk prediction