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Article: Relationship between changes in heart rate recovery after cardiac rehabilitation on cardiovascular mortality in patients with myocardial infarction

TitleRelationship between changes in heart rate recovery after cardiac rehabilitation on cardiovascular mortality in patients with myocardial infarction
Authors
KeywordsCardiac death
Cardiac rehabilitation
Exercise
Heart rate recovery
Myocardial infarction
Issue Date2010
PublisherElsevier Inc. The Journal's web site is located at http://www.elsevier.com/locate/heartrhythmjournal
Citation
Heart Rhythm, 2010, v. 7 n. 7, p. 929-936 How to Cite?
AbstractBackground: Heart rate recovery (HRR) at predischarge exercise stress test predicts all-cause mortality in patients with myocardial infarction (MI), but the relationship between improvement in HRR with exercise training and clinical outcomes remains unclear. Objective: The purpose of this study was to evaluate the effect of change in HRR after exercise training on clinical outcomes in MI patients. Methods: The study included 386 consecutive patients with recent MI who were enrolled into our cardiac rehabilitation program. All patients underwent symptom-limited treadmill testing at baseline and after exercise training, and were prospectively followed-up in the outpatient clinic. Results: Treadmill testing revealed significant improvement in HRR after 8 weeks of exercise training (17.5 ± 10.0 bpm to 19.0 ± 12.3 bpm, P = .011). After follow-up of 79 ± 41 months, 40 (10.4%) patients died of cardiac events. Multivariate Cox regression analysis revealed that diabetes (hazard ratio [HR] 2.28, 95% confidence interval [CI] 1.01-5.19, P = .049), statin use (HR 0.36, 95% CI 0.16-0.80, P = .012), baseline resting heart rate ≥65 bpm (HR 5.37, 95% CI 1.33-21.61, P = .018), post-training HRR <12 bpm (HR 2.49, 95% CI 1.10-5.63, P = .028), left ventricular ejection fraction ≤30% (HR 4.70, 95% CI 1.34-16.46, P = .016), and exercise capacity ≤4 metabolic equivalents (HR 3.63, 95% CI 1.17-11.28, P = .026) were independent predictors of cardiac death. Patients who failed to improve HRR from <12 bpm to ≥12 bpm after exercise training had significantly higher mortality (HR 6.2, 95% CI 1.3-29.2, P = .022). Conclusion: Exercise training improved HRR in patients with recent MI, and patients with HRR increased to ≥12 bpm had better cardiac survival. © 2010.
Persistent Identifierhttp://hdl.handle.net/10722/77730
ISSN
2015 Impact Factor: 4.391
2015 SCImago Journal Rankings: 2.756
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorHai, JJen_HK
dc.contributor.authorSiu, CWen_HK
dc.contributor.authorHo, HHen_HK
dc.contributor.authorLi, SWen_HK
dc.contributor.authorLee, Sen_HK
dc.contributor.authorTse, HFen_HK
dc.date.accessioned2010-09-06T07:35:06Z-
dc.date.available2010-09-06T07:35:06Z-
dc.date.issued2010en_HK
dc.identifier.citationHeart Rhythm, 2010, v. 7 n. 7, p. 929-936en_HK
dc.identifier.issn1547-5271en_HK
dc.identifier.urihttp://hdl.handle.net/10722/77730-
dc.description.abstractBackground: Heart rate recovery (HRR) at predischarge exercise stress test predicts all-cause mortality in patients with myocardial infarction (MI), but the relationship between improvement in HRR with exercise training and clinical outcomes remains unclear. Objective: The purpose of this study was to evaluate the effect of change in HRR after exercise training on clinical outcomes in MI patients. Methods: The study included 386 consecutive patients with recent MI who were enrolled into our cardiac rehabilitation program. All patients underwent symptom-limited treadmill testing at baseline and after exercise training, and were prospectively followed-up in the outpatient clinic. Results: Treadmill testing revealed significant improvement in HRR after 8 weeks of exercise training (17.5 ± 10.0 bpm to 19.0 ± 12.3 bpm, P = .011). After follow-up of 79 ± 41 months, 40 (10.4%) patients died of cardiac events. Multivariate Cox regression analysis revealed that diabetes (hazard ratio [HR] 2.28, 95% confidence interval [CI] 1.01-5.19, P = .049), statin use (HR 0.36, 95% CI 0.16-0.80, P = .012), baseline resting heart rate ≥65 bpm (HR 5.37, 95% CI 1.33-21.61, P = .018), post-training HRR <12 bpm (HR 2.49, 95% CI 1.10-5.63, P = .028), left ventricular ejection fraction ≤30% (HR 4.70, 95% CI 1.34-16.46, P = .016), and exercise capacity ≤4 metabolic equivalents (HR 3.63, 95% CI 1.17-11.28, P = .026) were independent predictors of cardiac death. Patients who failed to improve HRR from <12 bpm to ≥12 bpm after exercise training had significantly higher mortality (HR 6.2, 95% CI 1.3-29.2, P = .022). Conclusion: Exercise training improved HRR in patients with recent MI, and patients with HRR increased to ≥12 bpm had better cardiac survival. © 2010.en_HK
dc.languageengen_HK
dc.publisherElsevier Inc. The Journal's web site is located at http://www.elsevier.com/locate/heartrhythmjournalen_HK
dc.relation.ispartofHeart Rhythmen_HK
dc.subjectCardiac deathen_HK
dc.subjectCardiac rehabilitationen_HK
dc.subjectExerciseen_HK
dc.subjectHeart rate recoveryen_HK
dc.subjectMyocardial infarctionen_HK
dc.subject.meshCardiovascular Diseases - mortality-
dc.subject.meshExercise Therapy-
dc.subject.meshHeart Rate - physiology-
dc.subject.meshKaplan-Meier Estimate-
dc.subject.meshMyocardial Infarction - mortality - physiopathology - rehabilitation-
dc.titleRelationship between changes in heart rate recovery after cardiac rehabilitation on cardiovascular mortality in patients with myocardial infarctionen_HK
dc.typeArticleen_HK
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=1547-5271&volume=7&issue=7&spage=929&epage=936&date=2010&atitle=Relationship+between+changes+in+heart+rate+recovery+after+cardiac+rehabilitation+on+cardiovascular+mortality+in+patients+with+myocardial+infarctionen_HK
dc.identifier.emailSiu, CW:cwdsiu@hkucc.hku.hken_HK
dc.identifier.emailTse, HF:hftse@hkucc.hku.hken_HK
dc.identifier.authoritySiu, CW=rp00534en_HK
dc.identifier.authorityTse, HF=rp00428en_HK
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1016/j.hrthm.2010.03.023en_HK
dc.identifier.pmid20346416-
dc.identifier.scopuseid_2-s2.0-77954042346en_HK
dc.identifier.hkuros169692en_HK
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-77954042346&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume7en_HK
dc.identifier.issue7en_HK
dc.identifier.spage929en_HK
dc.identifier.epage936en_HK
dc.identifier.isiWOS:000279310400015-
dc.publisher.placeUnited Statesen_HK
dc.identifier.scopusauthoridHai, JJ=36174897800en_HK
dc.identifier.scopusauthoridSiu, CW=7006550690en_HK
dc.identifier.scopusauthoridHo, HH=7401465369en_HK
dc.identifier.scopusauthoridLi, SW=13807028100en_HK
dc.identifier.scopusauthoridLee, S=7601396808en_HK
dc.identifier.scopusauthoridTse, HF=7006070805en_HK

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