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Heart rate as an independent risk factor in patients with multiple organ dysfunction: a prospective, observational study

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Abstract

Purpose

To study the association between baseline heart rate and outcome in patients with multiple organ dysfunction (MODS) as well as the course of heart rate over the first 4 days during MODS.

Methods

Prospective observational study in 89 patients with MODS, defined as an APACHE-II score ≥20. Baseline heart rate (HR0) was determined over a 60-minute period at the time of MODS diagnosis. 28-day all-cause mortality was the primary endpoint of the study, a fall of the APACHE-II score by 4 points or more from day 0 to day 4 constituted the secondary endpoint. Hazard ratios for heart rate of 90 beats per minute (bpm) or greater relative to less than 90 bpm were calculated using Cox proportional hazards model and adjusted for confounding variables.

Results

Median baseline heart rate was 83 bpm in survivors and 92 bpm in non-survivors (p = 0.048). 28-day mortality was 32 and 61% in patients with HR0 < 90 bpm and HR0 ≥ 90 bpm, respectively. The adjusted hazard ratio for 28-day mortality was 2.30 (95% confidence interval 1.21–4.36, p = 0.001) for HR0 ≥ 90 bpm relative to HR0 < 90 bpm. No correlation was found between baseline heart rate and the secondary endpoint. From day 0 to day 4, heart rate remained elevated in all patients, as well as in survivors and non-survivors.

Conclusions

A heart rate ≥90 bpm at the time of MODS diagnosis is an independent risk factor for increased 28-day mortality. As in patients with cardiovascular conditions such as coronary heart disease or chronic heart failure, heart rate might constitute a target for heart rate-lowering therapy in the narrow initial treatment window of MODS.

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Abbreviations

APACHE:

Acute physiology and chronic health evaluation

BEAUTIFUL:

Morbidity-mortality evaluation of the If inhibitor ivabradine in patients with coronary disease and left ventricular dysfunction

bpm:

Beats per minute

CAD:

Coronary artery disease

CHF:

Chronic heart failure

CI:

Confidence interval

ECG:

Electrocardiogram

FDAR:

Frequency-dependent acceleration of relaxation

FFR:

Force-frequency relationship

ICU:

Intensive care unit

IQR:

Interquartile range

HHR:

Hourly heart rate

HR0 :

Baseline heart rate

MODS:

Multiple organ dysfunction

SHIFT:

Systolic heart failure treatment with If inhibitor ivabradine trial

SOFA:

Sequential organ failure assessment

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Acknowledgments

We are indebted to the patients who participated in the study as well as to the staff of our department for the support of our work.

Conflict of interest

K. Werdan is national study coordinator and consultant for Servier, manufacturer of Procoralan® (ivabradine) and has received speaker’s fees, and research grants from Servier. H. Ebelt has received research and travel grants from Servier. R. S. Hoke has received travel grants from Servier.

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Authors and Affiliations

  1. Department of Medicine, Halle (Saale) University Hospital, Ernst-Grube-Str. 40, 06097, Halle (Saale), Germany

    Robert S. Hoke, Ursula Müller-Werdan, Karl Werdan & Henning Ebelt

  2. Institute for Medical Epidemiology, Biometrics and Informatics, Martin Luther University Halle/Wittenberg, 06097, Halle (Saale), Germany

    Christine Lautenschläger

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  1. Robert S. Hoke
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  2. Ursula Müller-Werdan
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  3. Christine Lautenschläger
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  4. Karl Werdan
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Correspondence to Robert S. Hoke.

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Hoke, R.S., Müller-Werdan, U., Lautenschläger, C. et al. Heart rate as an independent risk factor in patients with multiple organ dysfunction: a prospective, observational study. Clin Res Cardiol 101, 139–147 (2012). https://doi.org/10.1007/s00392-011-0375-3

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