From the Division of Cardiology, Department of Medicine, University of
Oulu (H.V.H., T.H.M., K.E.J.A., T.S.), Research and Development Centre of the
Social Insurance Institution (P.P.), and Department of Geriatrics, University
of Turku (I.J.R., L.B.S.), Finland.
Correspondence to Heikki V. Huikuri, MD, Division of Cardiology, Department of Medicine, University of Oulu, Kajaanintie 50, 90220 Oulu, Finland. E-mail HEIKKI.HUIKURI{at}oulu.fi
Background—The prognostic role of
heart rate (HR) variability analyzed from 24-hour ECG
recordings in the general population is not well known. We
studied whether analysis of 24-hour HR behavior is able to
predict mortality in a random population of elderly subjects.
Methods and Results—A random sample of 347 subjects of
Conclusions—Power-law relationship of 24-hour HR variability is a
more powerful predictor of death than the traditional risk markers in
elderly subjects. Altered long-term behavior of HR implies an increased
risk of vascular causes of death rather than being a marker of any
disease or frailty leading to death.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Power-Law Relationship of Heart Rate Variability as a Predictor of Mortality in the Elderly
65 years
of age (mean, 73±6 years) underwent a comprehensive clinical
evaluation, laboratory tests, and 24-hour ECG recordings and
were subsequently followed up for 10 years. Various spectral and
nonspectral measures of HR variability were analyzed from the
baseline 24-hour ECG recordings. Risk factors for all-cause,
cardiac, cerebrovascular, cancer, and other causes of death were
assessed. By the end of 10-year follow-up, 184 subjects (53%) had died
and 163 (47%) were still alive. Seventy-four subjects (21%) had died
of cardiac disease, 37 of cancer (11%), 25 of cerebrovascular disease
(7%), and 48 (14%) of various other causes. Among all
analyzed variables, a steep slope of the power-law
regression line of HR variability (<-1.50) was the best
univariate predictor of all-cause mortality (odds ratio,
7.9; 95% confidence interval [CI], 3.7 to 17.0;
P<.0001). After adjusting for age and sex and including
all univariate predictors of mortality in the proportional
hazards analysis, ie, measures of HR variability, history of
heart disease, functional class, smoking, medication, and blood
cholesterol and glucose concentrations, all-cause mortality
was predicted only by the slope of HR variability (adjusted relative
risk, 1.74; 95% CI, 1.42 to 2.13; P<.0001) and a
history of congestive heart failure (adjusted relative risk, 1.70;
P=.0002). The slope of HR variability predicted both
cardiac (adjusted relative risk, 2.05; P=.0002) and
cerebrovascular death (adjusted relative risk, 2.84;
P=.0001) but not cancer or other causes of death.
Key Words: population • death, sudden • intervals • aging
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