What is the clinical evidence from this study?

Study design: Cohort. Population: Heart failure (n=47712). Intervention: 10 bpm higher resting heart rate vs. Baseline resting heart rate. Primary outcome: New-onset heart failure (women) (HR 1.15, 95% CI 1.03-1.28).

March 18, 2026Open Access

Sex-specific longitudinal changes in resting heart rate and all-cause heart failure: insights from the HUNT study

Resultado clave

Each 10 bpm higher resting heart rate was associated with a 15% higher risk of new-onset heart failure in women (HR 1.15) and a 9% higher risk in men (HR 1.09).

Diseño del estudio

Tipo

Cohort (n=47,712)

PICO estructurado

Does longitudinal change and trajectory of resting heart rate predict new-onset heart failure in adult men and women?

Población

47,712 adults (aged 20-101 years, 54% women) from the Trøndelag Health Study (HUNT) in Norway with at least two resting heart rate measurements. Excluded individuals with fewer than two RHR measurements or new-onset HF before the second/third RHR measurement.

Resultado

All-cause incident heart failure (new-onset HF) identified using hospital data and the Norwegian Cause of Death Registryhard clinical

Longitudinal increases in resting heart rate and persistently high resting heart rate trajectories are associated with an increased risk of new-onset heart failure in both men and women.

Resultado numérico

Estimación del efecto: HR 1.15 (95% CI 1.03-1.28)

Limitaciones

Requiring two RHR measurements resulted in the exclusion of 50% of otherwise eligible participants, which may have introduced selection bias.
Misclassification of HF is a potential limitation, though linkage to national health registers reduces this risk.
Information on HF phenotype was unavailable.
The potential impact of underdiagnosed diastolic dysfunction in the cohort remains unknown.
Potential collider bias in models adjusting for established cardiovascular disease and heart-rate-affecting medications.

Resumen

Aims To investigate sex-specific associations between longitudinal resting heart rate (RHR) and new-onset heart failure (HF) using RHR change and RHR trajectories. Methods Participants from the Trøndelag Health Study attending two or three surveys between 1995 and 2019 were included. We investigated the association between new-onset HF and RHR using RHR categories based on the standard deviation of baseline RHR (12 bpm), continuous RHR modeled using restricted cubic splines ( n = 47,712; mean 12-year follow-up), and latent class trajectory models ( n = 47,162; mean 7-year follow-up). Cox regression was used to estimate adjusted hazard ratios (HR) and 95% confidence intervals (95% CI). Results During follow-up, 2,880 of the 47,712 participants developed HF. The HF incidence rate was lower in women than men (4.27 vs. 5.68 per 1,000 person-years; ratio (95% CI) 0.67 (0.57–0.77). Baseline RHR was 74 bpm in women and 70 bpm in men, and 74% maintained their RHR (±12 bpm) from baseline to the second attendance (mean change −2 ± 12 bpm). Each 10 bpm higher RHR was associated with higher HF risk for both women and men with HRs (95% CI) 1.15 (1.03–1.28) and 1.09 (1.00–1.20), respectively. Participants with a high RHR trajectory had higher HF risk than the low RHR trajectory with HRs (95% CI) 1.43 (1.14–1.79) for women and 1.41 (1.16–1.72) for men. Conclusion All-cause HF was similarly associated with increased RHR and a high RHR trajectory for women and men. Estimating HF risk using RHR trajectories provided stronger associations than a single RHR measurement.

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