Heart rate at rest, exercise capacity, and mortality risk in veterans

Am J Cardiol. 2013 Nov 15;112(10):1605-9. doi: 10.1016/j.amjcard.2013.07.042. Epub 2013 Sep 13.


Heart rate (HR) at rest has been associated inversely with mortality risk. However, fitness is inversely associated with mortality risk and both increased fitness and β-blockade therapy affect HR at rest. Thus, both fitness and β-blockade therapy should be considered when HR at rest-mortality risk association is assessed. From 1986 to 2011, we assessed HR at rest, fitness, and mortality in 18,462 veterans (mean age = 58 ± 11 years) undergoing a stress test. During a median follow-up period of 10 years (211,398 person-years), 5,100 died, at an average annual mortality of 24.1 events/1,000 person-years. After adjusting for age, body mass index, cardiac risk factors, medication, and exercise capacity, we noted approximately 11% increase in risk for each 10 heart beats. To assess the risk in a wide and clinically relevant spectrum, we established 6 HR at rest categories per 10 heart beat intervals ranging from <60 to ≥100 beats. Mortality risk was significantly elevated at a HR at rest of ≥70 beats/min (hazard ratio 1.14, confidence interval 1.04 to 1.25; p <0.006) and increased progressively to 49% (hazard ratio 1.49, confidence interval 1.29 to 1.73; p <0.001) for those with a HR at rest of ≥100 beats/min. Similar trends were noted when for subjects aged <60 and ≥60 years and those treated with β blockers. In all assessments, mortality risk was consistently overestimated when fitness was not considered. In conclusion, HR at rest-mortality risk association was direct and independent. A progressive increase in risk was noted >70 beats/min for the entire cohort, those treated with β blockers, and those aged <60 and ≥60 years. Mortality risk was overestimated slightly when fitness status was not considered.

Publication types

  • Comparative Study
  • Multicenter Study

MeSH terms

  • Aged
  • Cardiovascular Diseases / mortality*
  • Cardiovascular Diseases / physiopathology
  • Confidence Intervals
  • Exercise Test
  • Exercise Tolerance / physiology*
  • Female
  • Heart Rate / physiology*
  • Humans
  • Male
  • Middle Aged
  • Rest / physiology*
  • Retrospective Studies
  • Risk Assessment / methods*
  • Risk Factors
  • United States / epidemiology
  • Veterans*