Heart rate variability risk score for prediction of acute cardiac complications in ED patients with chest pain - 31/07/13
, Ken Goh, MD b , Stephanie Fook-Chong c , Benjamin Haaland, PhD d , Khin Lay Wai, MBBS e , Zhi Xiong Koh a , Nur Shahidah a , Zhiping Lin, PhD f Abstract |
Background |
We aimed to develop a risk score incorporating heart rate variability (HRV) and traditional vital signs for the prediction of early mortality and complications in patients during the initial presentation to the emergency department (ED) with chest pain.
Methods |
We conducted a prospective observational study of patients with a primary complaint of chest pain at the ED of a tertiary hospital. The primary outcome was a composite of mortality, cardiac arrest, ventricular tachycardia, hypotension requiring inotropes or intraaortic balloon pump insertion, intubation or mechanical ventilation, complete heart block, bradycardia requiring pacing, and recurrent ischemia requiring revascularization, all within 72 hours of arrival at ED.
Results |
Three hundred nine patients were recruited, and 25 patients met the primary outcome. Backwards stepwise logistic regression was used to derive a scoring model that included heart rate, systolic blood pressure, respiratory rate, and low frequency to high frequency ratio. For predicting complications within 72 hours, the risk score performed with an area under the curve of 0.835 (95% confidence interval [CI], 0.749-0.920); and a cutoff of 4 and higher in the risk score gave a sensitivity of 0.880 (95% CI, 0.677-0.968), specificity of 0.680 (95% CI, 0.621-0.733), positive predictive value of 0.195, and negative predictive value of 0.985. The risk score performed better than ST elevation/depression and troponin T in predicting complications within 72 hours.
Conclusion |
A risk score incorporating heart rate variability and vital signs performed well in predicting mortality and other complications within 72 hours after arrival at ED in patients with chest pain.
Le texte complet de cet article est disponible en PDF.Abbreviations : ACS, AF, AMI, AUC, CABG, CI, ECG, ED, HFP, HRV, IRB, LFP, PACS, PCI, ROC, SBP, SGH, VLFP, VT
Plan
| ☆ | Authors' contributions: MEHO planned and established the project, including the procedures for data collection; drafted the manuscript; and performed data analysis. KG drafted the manuscript and performed data collection and data analysis. SF, BH, and KLW performed detailed statistical analysis of the data. KG, ZXK, and NS performed data collection and data analysis. ZL reviewed critical revisions to the manuscript. All authors read and approved the final manuscript. |
| ☆☆ | Conflict of interest: The study sponsor had no involvement in the study design, data collection, data analysis and interpretation, and writing of the manuscript. Dr Marcus Ong and A/Prof Lin Zhiping had a patent filing related to the technology described in the study (Method of predicting acute cardiopulmonary events and survivability of a patient, Application Number: 13/047,348). Dr Marcus Ong and A/Prof Lin Zhiping also had a licensing agreement with ZOLL Medical Corporation for the technology. All the other authors do not have either commercial or personal associations or any sources of support that might pose a conflict of interest in the subject matter or materials discussed in this manuscript. |
| ★ | This study was sponsored by ZOLL Medical Corporation. |
Vol 31 - N° 8
P. 1201-1207 - août 2013 Retour au numéro
Article précédent
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