Prognostic value of heart rate variability in chronic congestive heart failure (Veterans Affairs’ Survival Trial of Antiarrhythmic Therapy in Congestive Heart Failure)
Abstract
Although the value of heart rate variability (HRV) for risk stratification after acute myocardial infarction has been demonstrated, the value of low HRV as a predictor of sudden cardiac death in patients with ischemic cardiomyopathy has not been shown convincingly to date. We retrospectively analyzed electrocardiographic data from 179 patients in the Veterans Affairs' Survival Trial of Antiarrhythmic Therapy in Congestive Heart Failure to determine if HRV (expressed as the SD of the normal-to-normal RR intervals [SDNN]) would be useful as a predictor of overall mortality and sudden death. Because our goal was to identify high-risk patients, we compared patients in the lowest quartile of HRV with the remaining patients. Among the 127 patients meeting inclusion criteria, SDNN <65.3 ms (the lowest quartile) was the sole independent factor predictive of survival in a multivariate model (p = 0.0001). A Cox proportional-hazards model revealed that each increase of 10 ms in SDNN conferred a 20% decrease in risk of mortality (p = 0.0001). Furthermore, patients with SDNN <65.3 ms had a significantly increased risk of sudden death (p = 0.016). Thus, HRV was the sole independent predictor of overall mortality and was significantly associated with sudden death in this population.
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Sudden death, increased morbidity and mortality following cardiac surgery in hostile or depressed patients, and increased death rates in patients with sepsis or organ failure are linked clinically to decreased vagus nerve activity.
“Sudden death, increased morbidity and mortality following cardiac surgery in hostile or depressed patients, and increased death rates in patients with sepsis or organ failure are linked clinically to decreased vagus nerve activity (50)(51)(52)(53)(54).”
From Physiology and immunology of the cholinergic antiinflammatory pathway (2007) · cites this paper as [52]
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- Authors
- Bilchick, K. C., Fetics, B., Djoukeng, R., Gross Fisher, S., Fletcher, R. D., Singh, S. N., Nevo, E., & Berger, R. D.
- Affiliations
- Johns Hopkins University (US)
- United States Department of Veterans Affairs (US)
- Venue
- The American Journal of Cardiology
- Publisher
- Elsevier BV
- Published
- 2002-07
- Volume
- 90
- Issue
- 1
- Pages
- 24-28
- ISSN
- 0002-9149 (ISSN-L)
- OpenAlex
- W2122859962
- Cited by
- 288
- References
- 20
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 8 · 2023: 6 · 2022: 3 · 2021: 17 · 2020: 13 · 2019: 12 · 2018: 12 · 2017: 14 · 2016: 10 · 2015: 9 · 2014: 16 · 2013: 15 · 2012: 10
- FWCI
- 10.92
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The American Journal of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5r44hl061903-03)
- National Heart, Lung, and Blood Institute (P50-HL52307, P50HL052307, R44 HL61903)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Keywords
- heart rate variability, chronic congestive heart failure, SDNN, all-cause mortality, sudden cardiac death, risk stratification, antiarrhythmic therapy, veterans
- MeSH terms
- Aged, Amiodarone, Anti-Arrhythmia Agents, Arrhythmias, Cardiac, Chronic Disease, Female, Heart Failure, Heart Rate, Humans, Male, Predictive Value of Tests, Prognosis, Retrospective Studies, Risk Factors, Stroke Volume, United States, United States Department of Veterans Affairs, Electrocardiography, Ambulatory, Comorbidity, Multivariate Analysis, Proportional Hazards Models, Survival Analysis, Death, Sudden, Cardiac, Myocardial Ischemia
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