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

Abstract Background Investigation of sex-specific associations between longitudinal resting heart rate (RHR) and new-onset heart failure (HF) using both change in RHR and RHR trajectories. Methods Participants from the Trøndelag Health Study attending two or three surveys between 1995-2019 were included. We investigated the association between new-onset HF and RHR, using RHR categories according to the mean baseline RHR standard deviation (12 bpm), continuous RHR in restricted cubic splines (n=47712, mean 12-year follow-up), and latent class trajectory models (n=47162, 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, 2880 of the 47712 participants developed HF. The HF incidence rate was lower in women than men (4.27 vs. 5.68 per 1000 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 their second attendance (mean change -2±12 bpm). Each 10-bpm higher RHR was associated with higher risk of HF for both women and men with HR (95% CI) 1.15 (1.03-1.28) and 1.09 (1.00-1.20), respectively. Participants with a high RHR trajectory had higher risk of HF compared to the low RHR-trajectories with HR (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 between RHR and HF compared to using a single RHR measurement. Lay summary We investigated sex-specific associations between longitudinal resting heart rate (RHR) and all-cause new-onset of heart failure for 47 712 participants from the Trøndelag Health Study, using RHR categories, continuous RHR in restricted cubic splines, and latent class trajectory models. Each 10-bpm increase in RHR was associated with a similar higher risk of heart failure for both women and men, with 15% higher risk for women and 9% higher for men Participants with a high RHR trajectory had 41-43% increased risk of heart failure compared to the low RHR-trajectory Long term RHR measurements can reveal changes in HF risk profiles that might not be detectable with a single RHR measurement and highlight individuals with a high RHR who should be further evaluated Abstract Figure Graphical abstract. Sex-specific associations between longitudinal resting heart rate (RHR) and heart failure (HF) from The Trøndelag Health Study, 1995-2019. In fully adjusted analyses, women and men with an increase in RHR or a high RHR trajectory had a similar risk of developing all-cause new-onset HF.