Impact of Heart Rate Dynamics on Mortality in the Early Phase after XXXX : A Prospective Observational Trial.

@entity1 @entity299 @entity204 @entity65 @entity385
BACKGROUND: Growing evidence suggests that the heart rate (HR) at rest is an independent predictor of @entity65 . In @entity385 , continuous monitoring of HR is the standard of care, but systematic data on its dynamics and prognostic value during the acute phase are limited. METHODS: In this prospective observational study, HR was measured by continuous electrocardiographic monitoring on admission and during the first 72  hours of care among @entity1 who were awake with @entity385 and survived until discharge. Functional outcome was assessed after 90  days. RESULTS: Data from 702 consecutive @entity1 were analyzed (median age, 73  years, 54% @entity1 ). The time course of HR was initially characterized by a rapid decline during the first 12  hours after admission. Among @entity1 who survived until day 90, this was followed by a continuous downward trend in HR, whereas @entity204 after discharge was associated with a secondary increase and a reversal point 12  hours after admission. After adjustment for established risk factors, this secondary increase during the acute period was an independent predictor of @entity204 (hazard ratio, 3.73; 95% confidence interval, 1.47-9.43; P  =  .005). CONCLUSIONS: A secondary rise of HR during care for acute @entity385 is an early  sign of fatality and may represent a surrogate for an unfavorable sympathetic disinhibition. Further research is warranted to clarify the role of targeted @entity299 after  @entity385 (http://clinicaltrials.gov/, unique identifier NCT01858779).
