Key result
An increase in the rhythm-adjusted mean heart rate (Mesor) by 10 bpm was associated with a 1.17-fold increased risk of in-hospital mortality in stroke and critically ill patients.
Why the study?
Data demonstrating the impact of dysregulated heart rate circadian rhythm on outcomes in stroke and critically ill patients were scarce.
Does dysregulated heart rate circadian rhythm increase in-hospital mortality in stroke and critically ill patients?
Cohort (n=6,201)
Yes
Does dysregulated heart rate circadian rhythm increase in-hospital mortality in stroke and critically ill patients?
Odds Ratio: 1.17 (95% CI 1.11–1.24)
p-value: p=<0.001
Dysregulation of heart rate circadian rhythm is an independent risk factor for in-hospital mortality in stroke and critically ill patients, and adds incremental prognostic value to the APACHE IV score.
HR circadian parameters were associated with higher in-hospital mortality; leaves open whether they meaningfully improve risk stratification beyond APACHE IV.
Background: The dysregulation of the heart rate circadian rhythm has been documented to be an independent risk factor in multiple diseases. However, data showing the impact of dysregulated heart rate circadian rhythm in stroke and critically ill patients are scarce.Methods: Stroke and critically ill patients in the ICU between 2014 and 2015 from the recorded eICU Collaborative Research Database were included in the current analyses. The impact of circadian rhythm of heart rate on in-hospital mortality was analyzed. Three variables, Mesor (rhythm-adjusted mean of heart rate), Amplitude (distance from the highest point of circadian rhythm of heart rate to Mesor), and Peak time (time when the circadian rhythm of heart rate reaches the highest point) were used to evaluate the heart rate circadian rhythm. The incremental value of circadian rhythm variables in addition to Acute Physiology and Chronic Health Evaluation (APACHE) IV score to predict in-hospital mortality was also explored.Results: A total of 6,201 eligible patients were included. The in-hospital mortality was 16.2% (1,002/6,201). The circadian rhythm variables of heart rate, Mesor, Amplitude, and Peak time, were identified to be independent risk factors of in-hospital mortality. After adjustments, Mesor per 10 beats per min (bpm) increase was associated with a 1.17-fold (95%CI: 1.11, 1.24, P<0.001) and Amplitude per 5 bpm was associated with a 1.14-fold (95%CI: 1.06, 1.24, P<0.001) increase in the risk of in-hospital mortality, respectively. The risk of in-hospital mortality was lower in patients who had Peak time reached between 18:00-24:00 or 00:00-06:00; whereas the risk was highest in patients who had Peak time reached between 12:00-18:00 (OR: 1.33, 95%CI: 1.05, 1.68, P=0.017). Compared with APACHE IV score only (c-index=0.757), combining APACHE IV score and circadian rhythm variables of heart rate (c-index=0.766) was associated with increased discriminative ability (P=0.003).Conclusion: Circadian rhythm of heart rate is an independent risk factor of the in-hospital mortality in stroke and critically ill patients. Including circadian rhythm variables regarding heart rate might increase the discriminative ability of the risk score to predict the short-term prognosis of patients.
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Yang et al. (2022) conducted a cohort in Stroke and critically ill (n=6,201). Heart rate circadian rhythm (Mesor) vs. Lower Mesor was evaluated on In-hospital mortality (OR 1.17, 95% CI 1.11, 1.24, p=<0.001). An increase in the rhythm-adjusted mean heart rate (Mesor) by 10 bpm was associated with a 1.17-fold increased risk of in-hospital mortality in stroke and critically ill patients.
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