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Effect of heart rate on hospital mortality in critically ill patients may be modified by age: a retrospective observational study from large database

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Abstract

Background

Heart rate has been found associated with mortality in critically ill patients. However, whether the association differs between the elderly and non-elderly patients was unknown.

Methods

We conducted a retrospective observational study of adult patients admitted to the intensive care unit (ICU) in the United States. Demographic, vital signs, laboratory tests, and interventions were extracted and compared between the elderly and non-elderly patients. The main exposure was heart rate, the proportion of time spent in heart rate (PTS-HR) was calculated. The primary outcome was hospital mortality. The multivariable logistic regression model was performed to assess the relationship between PTS-HR and hospital mortality, and interaction between PTS-HR and age categories was explored.

Results

104,276 patients were included, of which 52,378 (50.2%) were elderly patients and 51,898 (49.8%) were non-elderly patients. The median age was 66 (IQR 54–76) years. After adjusting for confounders, PTS-HR < 60 beats per minute (bpm) (OR 0.972, 95% CI [0.945, 0.998], p = 0.031, Pinteraction = 0.001) and 60–80 bpm (OR 0.925, 95% CI [0.912, 0.938], p < 0.001, Pinteraction = 0.553) were associated with decreased risk of mortality; PTS-HR 80–100 bpm was associated with decreased mortality in the non-elderly patients (OR 0.955, 95% CI [0.941,0.975], p < 0.001) but was associated with increased mortality in the very elderly patients (OR 1.018, 95% CI [1.003,1.029], p = 0.017, Pinteraction < 0.001). PTS-HR > 100 bpm (OR 1.093, 95% CI [1.081,1.105], p < 0.001, Pinteraction = 0.004) was associated with increased mortality.

Conclusions

The effect of heart rate on hospital mortality differs between the elderly and non-elderly critically ill patients.

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Availability of data and materials

Data analyzed during the present study are currently stored in the eICU database (eicu-crd.mit.edu).

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Funding

This study was supported by grants from ‘Beijing Municipal Science and Technology Commission-Capital clinical application research’ (Z181100001718068).

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Authors and Affiliations

  1. Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China

    Dawei Zhou, Zhimin Li, Guangzhi Shi & Jianxin Zhou

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  1. Dawei Zhou
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  2. Zhimin Li
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  3. Guangzhi Shi
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Contributions

DZ and JZ conceived this study. DZ extracted the data. DZ, and ZL designed the statistical analyses. DZ, JZ performed the statistical analyses. DZ and ZL wrote the first draft of the manuscript. GS and JZ reviewed and modified the final manuscript. All authors read, critically reviewed, and approved the final manuscript.

Corresponding authors

Correspondence to Guangzhi Shi or Jianxin Zhou.

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Conflict of interest

None of the authors has declared a conflict of interest.

Ethical approval

The schema of eICU database was established in collaboration with Privacert (Cambridge, MA), who certified the re-identification risk as meeting safe harbor standards (HIPAA Certification no. 1031219-2). All tables in eICU database were deidentified to meet the safe harbor provision of the US HIPAA. Due to the HIPAA compliant de-identification in this database, our institutional review board requirement was waived.

Statement of human and animal rights

This article is a secondary data analysis from the eICU database, and all necessary permissions were obtained to access and use the data. The present work adhered to the rules regulating research for humans and was conducted strictly according to the Declaration of Helsinki.

Informed consent

Informed consent from participants was waived because the study was retrospective, and the eICU database contains de-identified information, which does not affect the rights and welfare of the participants.

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Not applicable.

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Zhou, D., Li, Z., Shi, G. et al. Effect of heart rate on hospital mortality in critically ill patients may be modified by age: a retrospective observational study from large database. Aging Clin Exp Res 33, 1325–1335 (2021). https://doi.org/10.1007/s40520-020-01644-7

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  • DOI: https://doi.org/10.1007/s40520-020-01644-7

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