Heart Rate Recovery after Submaximal Exercise Testing as a Predictor of Mortality in a Cardiovascularly Healthy Cohort

Heart Rate Recovery after Submaximal Exercise Testing as a Predictor of Mortality in a Cardiovascularly Healthy Cohort

From Cleveland Clinic Foundation, Cleveland, Ohio.

Abstract

Background: Abnormal heart rate recovery after symptom-limited exercise predicts death. It is unknown whether this is also true among patients undergoing submaximal testing.

Objective: To test the prognostic implications of heart rate recovery in cardiovascularly healthy adults undergoing submaximal exercise testing.

Design: Population-based cohort study.

Setting: 10 primary care sites.

Participants: 5234 adults without evidence of cardiovascular disease who were enrolled in the Lipid Research Clinics Prevalence Study.

Measurements: Heart rate recovery was defined as the change from peak heart rate to that measured 2 minutes later (heart rate recovery was defined as ≤ 42 beats/min).

Results: During 12 years of follow-up, 312 participants died. Abnormal heart rate recovery predicted death (relative risk, 2.58 [CI, 2.06 to 3.20]). After adjustment for standard risk factors, fitness, and resting and exercise heart rates, abnormal heart rate recovery remained predictive (adjusted relative risk, 1.55 [CI, 1.22 to 1.98]) (P < 0.001).

Conclusion: Even after submaximal exercise, abnormal heart rate recovery predicts death.

Article and Author Information

Disclaimer: This paper uses data supplied by the National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services. The views expressed in this paper are those of the authors and do not necessarily reflect the views of the National Heart, Lung, and Blood Institute.
Grant Support: Dr. Lauer is the recipient of an Established Investigator Grant from the American Heart Association.
Requests for Single Reprints: Michael S. Lauer, MD, Desk F25, Section of Heart Failure and Cardiac Transplantation Medicine, Department of Cardiology, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195; e-mail, lauerm{at}ccf.org.
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Current Author Addresses: Drs. Cole and Foody: Desk F15, Department of Cardiology, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195.
Dr. Blackstone: Desk F25, Departments of Cardiothoracic Surgery and Epidemiology and Biostatistics, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195.
Dr. Lauer: Desk F25, Section of Heart Failure and Cardiac Transplantation Medicine, Department of Cardiology, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio 44195.
Author Contributions: Conception and design: C.R. Cole, M.S. Lauer.
Analysis and interpretation of the data: C.R. Cole, J.M. Foody, E.H. Blackstone, M.S. Lauer.
Drafting of the article: C.R. Cole, J.M. Foody, M.S. Lauer.
Critical revision of the article for important intellectual content: C.R. Cole, J.M. Foody, E.H. Blackstone, M.S. Lauer.
Final approval of the article: C.R. Cole, J.M. Foody, E.H. Blackstone, M.S. Lauer.
Statistical expertise: E.H. Blackstone, M.S. Lauer.
Obtaining of funding: M.S. Lauer.
Administrative, technical, or logistic support: J.M. Foody.
Collection and assembly of data: C.R. Cole, J.M. Foody, M.S. Lauer.