![Sample our Medicine, Dentistry, Nursing & Allied Health journals, sign in here to start your FREE access for 14 days]({"type":"image" , "src" : "/sda/5944/TOC-Subject-Sample-2021-Medicine-Dentistry-Nursing-Allied-Health.jpg"})
Abstract
Background
We sought to examine the prognostic value of heart rate turbulence derived from electrocardiographic recordings initiated in the emergency department for patients with non-ST elevation myocardial infarction (NSTEMI) or unstable angina.
Methods
Twenty-four-hour Holter recordings were started in patients with cardiac symptoms approximately 45 minutes after arrival in the emergency department. Patients subsequently diagnosed with NSTEMI or unstable angina who had recordings with ≥18 hours of sinus rhythm and sufficient data to compute Thrombolysis In Myocardial Infarction (TIMI) risk scores were chosen for analysis (n = 166). Endpoints were emergent re-entry to the cardiac emergency department and/or death at 30 days and one year.
Results
In Cox regression models, heart rate turbulence and TIMI risk scores together were significant predictors of 30-day (model chi square 13.200, P = 0.001, C-statistic 0.725) and one-year (model chi square 31.160, P < 0.001, C-statistic 0.695) endpoints, outperforming either measure alone.
Conclusion
Measurement of heart rate turbulence, initiated upon arrival at the emergency department, may provide additional incremental value in the risk assessment for patients with NSTEMI or unstable angina.
Acknowledgments
The authors are grateful to the team at the Drew Electrocardiographic Monitoring Research Laboratory, the University of California, San Francisco School of Nursing, and the investigators who performed the IMMEDIATE AIM study; the research team at the Heart Rate Variability Laboratory, School of Medicine, Washington University, St Louis, MO, USA; and the patients who agreed to participate in this research.
Disclosure
The authors have no relevant financial or nonfinancial relationships to disclose in this work.