Electrocardiographic PR Interval and Adverse Outcomes in Older Adults

Q: What are the key findings of this study?

Every 1-SD (29 ms) increase in baseline PR interval was associated with a 13% increased 10-year risk of both incident heart failure and atrial fibrillation in older adults.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Community-dwelling older adults free of prevalent arrhythmias or functional disability (n=2722). Intervention: Baseline electrocardiographic PR interval (per 1-SD [29 ms] increase and >200 ms) vs. Shorter PR interval (<=200 ms or per 1-SD lower). Primary outcome: 10-year risk of incident heart failure (per 1-SD [29 ms] increase in baseline PR interval) (HR 1.13, 95% CI 1.02-1.25).

Q: What does this research mean for the field?

In older adults, each standard deviation increase in electrocardiographic PR interval is associated with a 13% increased 10-year risk of both incident heart failure and atrial fibrillation. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Jared W. Magnani; Na Wang; Kerrie P. Nelson; Stephanie Connelly; Rajat Deo; Nicolas Rodondi; Erik B. Schelbert; Melissa E. Garcia; Caroline L. Phillips; Michael G. Shlipak; Tamara B. Harris; Patrick T. Ellinor; Emelia J. Benjamin

doi:10.1161/circep.112.975342

December 18, 2012Circulation Arrhythmia and ElectrophysiologyOpen Access

Electrocardiographic PR Interval and Adverse Outcomes in Older Adults

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Key result

Longer PR interval is linked to ~13% higher 10-year heart failure risk per SD.

HR 1.13
95% CI 1.02-1.25
n=2,722

Why the study?

Is a prolonged baseline electrocardiographic PR interval associated with increased 10-year risks of incident heart failure, atrial fibrillation, and all-cause mortality in a biracial cohort of older adults?

Key Points

To determine the associations between electrocardiographic PR interval and 10-year risks of heart failure, atrial fibrillation, and all-cause mortality in a biracial cohort of older adults.
Prospective cohort study of 2722 Health ABC participants (aged 74±3 years, 51.9% women, 41% Black) followed for 10 years.
Multivariable Cox proportional hazards models adjusted for demographic, anthropometric, and clinical cardiovascular risk factors to evaluate PR interval per standard deviation increase (29 ms) and prolonged PR interval (>200 ms).
Each 1-SD increase (29 ms) in PR interval was associated with a 13% increased 10-year risk of heart failure (HR, 1.13; 95% CI, 1.02 to 1.25) and incident atrial fibrillation (HR, 1.13; 95% CI, 1.04 to 1.23).
A PR interval >200 ms was associated with a 46% increased risk of incident heart failure (95% CI, 1.11 to 1.93), but was not significantly associated with atrial fibrillation (HR, 1.26; 95% CI, 0.99 to 1.61) or all-cause mortality (HR, 1.16; 95% CI, 0.96 to 1.39).
No significant effect modification by race was identified for heart failure (P=0.26), atrial fibrillation (P=0.89), or all-cause mortality (P=0.66).

Study Design

Type

Cohort (n=2,722)

Blinding

ECG analysis was blinded to participant demographics

Multicenter

Yes

Structured PICO

Is a prolonged baseline electrocardiographic PR interval associated with increased 10-year risks of incident heart failure, atrial fibrillation, and all-cause mortality in a biracial cohort of older adults?

P

Population

2,722 community-dwelling biracial older adults (mean age 74 years, 52.4% female, 41.0% black) from the Health ABC Study, followed for 10 years.

E

Exposure

Prolonged baseline 12-lead electrocardiographic PR interval, evaluated continuously per 1-SD (29 ms) increase and dichotomized as >200 ms (n=339 with PR >200 ms)

C

Comparator

Lower baseline PR interval, evaluated continuously per 1-SD decrease, dichotomized as <=200 ms, or compared against the cohort mean/median referent value of 170 ms in spline models

O

Outcome

10-year risks of incident adjudicated heart failure (requiring overnight hospitalization), incident atrial fibrillation (ascertained via CMS ICD-9 codes 427.31 or 427.32), and adjudicated all-cause mortalityhard clinical

Main Result

Hazard Ratio: 1.13 (95% CI 1.02–1.25)

In a biracial cohort of older adults, prolongation of the baseline ECG PR interval independently predicts 10-year incident heart failure and atrial fibrillation without racial interaction, but is not associated with all-cause mortality.

Limitations

Enrolled highly functional white and black older adults in two US regions (Memphis, TN, and Pittsburgh, PA), limiting generalizability to other races, ethnicities, regions, and less healthy older adults
Atrial fibrillation was not an adjudicated study endpoint and relied on CMS ICD-9 coding, which may result in misclassification
Heart failure events were determined by review of hospitalizations, potentially underestimating mild cases and biasing toward more severe heart failure, without distinguishing preserved vs reduced ejection fraction
Lack of baseline echocardiography (diastolic indices, systolic function, chamber sizes, left ventricular mass)
Reliance on a single baseline determination of PR interval without accounting for variability over time or residual confounding
Cohort restricted to highly functional white and black older adults in Memphis, TN, and Pittsburgh, PA, limiting generalizability to other races/ethnicities, regions, and less healthy older adults
Atrial fibrillation was not an adjudicated outcome and relied on CMS ICD-9 coding, which may result in misclassification
Heart failure ascertainment required overnight hospitalization, which may underestimate cases and could not distinguish between preserved and reduced ejection fraction
Lack of baseline echocardiography (diastolic indices, systolic function, chamber sizes, and left ventricular mass)
Single baseline determination of PR interval with potential residual confounding from PR variability and unmeasured clinical variables

Ask about this paper

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Implication

Prolonged PR interval may flag higher HF/AF risk in older adults; leaves open its added value for risk stratification beyond standard predictors.

Abstract

BACKGROUND: The electrocardiographic PR interval increases with aging, differs by race, and is associated with atrial fibrillation (AF), pacemaker implantation, and all-cause mortality. We sought to determine the associations between PR interval and heart failure, AF, and mortality in a biracial cohort of older adults. METHODS AND RESULTS: The Health, Aging, and Body Composition (Health ABC) Study is a prospective, biracial cohort. We used multivariable Cox proportional hazards models to examine PR interval (hazard ratios expressed per SD increase) and 10-year risks of heart failure, AF, and all-cause mortality. Multivariable models included demographic, anthropometric, and clinical variables in addition to established cardiovascular risk factors. We examined 2722 Health ABC participants (aged 74±3 years, 51.9% women, and 41% black). We did not identify significant effect modification by race for the outcomes studied. After multivariable adjustment, every SD increase (29 ms) in PR interval was associated with a 13% greater 10-year risk of heart failure (95% confidence interval, 1.02-1.25) and a 13% increased risk of incident AF (95% confidence interval, 1.04-1.23). PR interval >200 ms was associated with a 46% increased risk of incident heart failure (95% confidence interval, 1.11-1.93). PR interval was not associated with increased all-cause mortality. CONCLUSIONS: We identified significant relationships of PR interval to heart failure and AF in older adults. Our findings extend prior investigations by examining PR interval and associations with adverse outcomes in a biracial cohort of older men and women.

Discussion

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Cite This Study

Magnani et al. (2012) conducted a cohort in Community-dwelling older adults free of prevalent arrhythmias or functional disability (n=2,722). Baseline electrocardiographic PR interval (per 1-SD [29 ms] increase and >200 ms) vs. Shorter PR interval (<=200 ms or per 1-SD lower) was evaluated on 10-year risk of incident heart failure (per 1-SD [29 ms] increase in baseline PR interval) (HR 1.13, 95% CI 1.02-1.25). Every 1-SD (29 ms) increase in baseline PR interval was associated with a 13% increased 10-year risk of both incident heart failure and atrial fibrillation in older adults.

synapsesocial.com/papers/6a7da1521b4d300315045253 https://doi.org/10.1161/circep.112.975342

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Electrocardiographic PR Interval and Adverse Outcomes in Older Adults

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Electrocardiographic PR Interval and Adverse Outcomes in Older Adults

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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