Heart Rate Recovery and Risk of Cardiovascular Events and All-Cause Mortality: A Meta-Analysis of Prospective Cohort Studies

Background-Heart rate recovery (HRR) is a noninvasive assessment of autonomic dysfunction and has been implicated with risk of cardiovascular events and all-cause mortality. However, evidence has not been systematically assessed. We performed a meta-analysis of prospective cohort studies to quantify these associations in the general population. Methods and Results-A literature search using 3 databases up to August 2016 was conducted for studies that reported hazard ratios with 95% CIs for the association between baseline HRR and outcomes of interest. The overall hazard ratios were calculated using a random-effects model. There were 9 eligible studies in total, with 5 for cardiovascular events enrolling 1061 cases from 34 267 participants, and 9 for all-cause mortality enrolling 2082 cases from 41 600 participants. The pooled hazard ratios associated with attenuated HRR versus fast HRR that served as the referent were 1.69 (95% CI 1.05-2.71) for cardiovascular events and 1.68 (95% CI 1.51-1.88) for all-cause mortality. For every 10 beats per minute decrements in HRR, the hazard ratios were 1.13 (95% CI 1.05-1.21) and 1.09 (95% CI 1.01-1.19), respectively. Further analyses suggested that the associations observed between attenuated HRR and risk of fatal cardiovascular events and all-cause mortality were independent of traditional metabolic factors for cardiovascular disease (all P<0.05). Conclusions-Attenuated HRR is associated with increased risk of cardiovascular events and all-cause mortality, which supports the recommendation of recording HRR for risk assessment in clinical practice as a routine.