Heart rate at discharge and long-term prognosis following percutaneous coronary intervention in stable and acute coronary syndromes — results from the BASKET PROVE trial

Jensen, Magnus Thorsten; Kaiser, Christoph; Sandsten, Karl Erik; Alber, Hannes; Wanitschek, Maria; Iversen, Allan; Jensen, Jan Skov; Pedersen, Sune; Soerensen, R; Rickli, Hans; Zurek, Marzena; Fahrni, Gregor; Bertel, Osmund; Servi, Stefano De; Erné, Paul; Pfisterer, Matthias; Galatius, Søren

doi:10.1016/j.ijcard.2013.06.034

Cited by 31 publications

(39 citation statements)

References 23 publications

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“…Several studies reported the negative impact of increased resting heart rate in healthy volunteers as well as in patients with chronic obstructive pulmonary disease and cardiovascular disease [1-3, 8, 18, 19]. A number of published articles focused on the influence of heart rate on patient outcome in the setting of an ACS [8,9,[18][19][20]. While there is good agreement in the finding that patients with heart rates above 90 bpm carry a greater risk of cardiovascular adverse events, there is conflicting evidence regarding the low heart rate groups of below 60 or below 50 bpm.…”

Section: Discussionmentioning

confidence: 99%

Admission heart rate in relation to presentation and prognosis in patients with acute myocardial infarction

Perné

Schmidt

Hochadel

et al. 2015

Herz

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Section: Discussionmentioning

confidence: 99%

Admission heart rate in relation to presentation and prognosis in patients with acute myocardial infarction

Perné

Schmidt

Hochadel

et al. 2015

Herz

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“…Previous studies have shown elevated RHR to be associated with low cardiorespiratory fitness [1] as well as other cardiovascular risk factors such as hypertension [3] and obesity, and markers of subclinical chronic inflammation such as C-reactive protein and fibrinogen [4]. A high RHR is prognostically associated with increased risk of adverse events in both general populations [5] and in patient populations such as patients with cardiovascular disease (CVD) [6], chronic obstructive pulmonary disease [7] and diabetes [8]. …”

Section: Introductionmentioning

confidence: 99%

Resting Heart Rate Is Not Associated with Cognitive Function

Wod¹,

Jensen

Galatius

et al. 2018

Neuroepidemiology

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Aims: In order to examine the hypothesis that elevated resting heart rate (RHR) is associated with impaired cognitive score, we investigated the relationship between RHR and cognitive score in middle-aged, elderly and old Danish subjects from the general population. Methods: Composite cognitive scores derived from the result of 5 age-sensitive cognitive tests for a total of 7,002 individuals (Middle-aged Danish twin: n = 4,132, elderly Danish twins: n = 2,104 and Danish nonagenarian: n = 766) divided according to RHR and compared using linear regression models adjusted for sex, age, previous heart conditions and hypertension. RHR was assessed by palpating radial pulse. Genetic and shared environmental confounding was addressed in intrapair analyses of 2,049 twin pairs. Results: In unadjusted multivariate models and in multivariable models adjusting for age, sex, heart conditions and hypertension, RHR was not associated with cognitive function. Furthermore, the intrapair analyses showed that RHR was not associated with cognitive score testing within twin pairs, as measured by the proportion of twin pairs in which the twin with higher RHR also was the twin with the lowest composite cognitive score (1,049 pairs of 2,049 pairs [51% (95% CI 49–53), p < 0.289]). Conclusion: While elevated RHR has been shown to be associated with adverse health events and poor fitness level, RHR has no relation to cognitive function in the general population.

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“…In 2008, two large trials of ivabradine, a pure heart rate-lowering agent without other known cardiovascular effects, showed controversial effects related to risk reduction for both stable and unstable coronary disease in patients with CAD and chronic heart failure, 237 and in patients without reduced left ventricular function with SCAD; 237 these results indicated conflicting scenarios for the mechanisms through which an increased heart rate could be involved in an increased risk of CVD. 238 Contemporary data regarding elevated heart rate and prognosis of CAD patients are derived from clinical trials or angiographic registries that are collected solely for research purposes and are confined to high-risk patients [238][239][240] or those admitted for ACS, 240,241 and not among the general population. 236,238 These data are biased by the selective nature of the populations studied and might compromise external validity.…”

Section: Introductionmentioning

confidence: 99%

“…237,242,243 The majority of studies have also failed to examine potential differences in heart rate effects on cardiovascular events between men and women, probably owing to limited sample sizes and subsequent restricted statistical power. 240,[244][245][246] The preponderance of composite cardiovascular end points in the published literature indicates the need for a study that will investigate the association of heart rate and specific cardiovascular events in a SCAD population.…”

Section: Introductionmentioning

confidence: 99%

Using nationwide ‘big data’ from linked electronic health records to help improve outcomes in cardiovascular diseases: 33 studies using methods from epidemiology, informatics, economics and social science in the ClinicAl disease research using LInked Bespoke studies and Electronic health Records (CALIBER) programme

Hemingway

Feder

Denaxas

et al. 2017

Programme Grants Appl Res

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BackgroundElectronic health records (EHRs), when linked across primary and secondary care and curated for research use, have the potential to improve our understanding of care quality and outcomes.ObjectiveTo evaluate new opportunities arising from linked EHRs for improving quality of care and outcomes for patients at risk of or with coronary disease across the patient journey.DesignEpidemiological cohort, health informatics, health economics and ethnographic approaches were used.Setting230 NHS hospitals and 226 general practices in England and Wales.ParticipantsUp to 2 million initially healthy adults, 100,000 people with stable coronary artery disease (SCAD) and up to 300,000 patients with acute coronary syndrome.Main outcome measuresQuality of care, fatal and non-fatal cardiovascular disease (CVD) events.Data platform and methodsWe created a novel research platform [ClinicAl disease research using LInked Bespoke studies and Electronic health Records (CALIBER)] based on linkage of four major sources of EHR data in primary care and national registries. We carried out 33 complementary studies within the CALIBER framework. We developed a web-based clinical decision support system (CDSS) in hospital chest pain clinics. We established a novel consented prognostic clinical cohort of SCAD patients.ResultsCALIBER was successfully established as a valid research platform based on linked EHR data in nearly 2 million adults with > 600 EHR phenotypes implemented on the web portal (seehttps://caliberresearch.org/portal). Despite national guidance, key opportunities for investigation and treatment were missed across the patient journey, resulting in a worse prognosis for patients in the UK compared with patients in health systems in other countries. Our novel, contemporary, high-resolution studies showed heterogeneous associations for CVD risk factors across CVDs. The CDSS did not alter the decision-making behaviour of clinicians in chest pain clinics. Prognostic models using real-world data validly discriminated risk of death and events, and were used in cost-effectiveness decision models.ConclusionsEmerging ‘big data’ opportunities arising from the linkage of records at different stages of a patient’s journey are vital to the generation of actionable insights into the diagnosis, risk stratification and cost-effective treatment of people at risk of, or with, CVD.Future workThe vast majority of NHS data remain inaccessible to research and this hampers efforts to improve efficiency and quality of care and to drive innovation. We propose three priority directions for further research. First, there is an urgent need to ‘unlock’ more detailed data within hospitals for the scale of the UK’s 65 million population. Second, there is a need for scaled approaches to using EHRs to design and carry out trials, and interpret the implementation of trial results. Third, large-scale, disease agnostic genetic and biological collections linked to such EHRs are required in order to deliver precision medicine and to innovate discovery.Study registrationCALIBER studies are registered as follows: study 2 – NCT01569139, study 4 – NCT02176174 and NCT01164371, study 5 – NCT01163513, studies 6 and 7 – NCT01804439, study 8 – NCT02285322, and studies 26–29 – NCT01162187. Optimising the Management of Angina is registered as Current Controlled Trials ISRCTN54381840.FundingThe National Institute for Health Research (NIHR) Programme Grants for Applied Research programme (RP-PG-0407-10314) (all 33 studies) and additional funding from the Wellcome Trust (study 1), Medical Research Council Partnership grant (study 3), Servier (study 16), NIHR Research Methods Fellowship funding (study 19) and NIHR Research for Patient Benefit (study 33).

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Heart rate at discharge and long-term prognosis following percutaneous coronary intervention in stable and acute coronary syndromes — results from the BASKET PROVE trial

Cited by 31 publications

References 23 publications

Admission heart rate in relation to presentation and prognosis in patients with acute myocardial infarction

Admission heart rate in relation to presentation and prognosis in patients with acute myocardial infarction

Resting Heart Rate Is Not Associated with Cognitive Function

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