Yamamoto Marumi, Ohta Yoshinori, Sakuma Mio, Takeuchi Jiro, Matsumoto Chisa, Morimoto Takeshi
Department of Clinical Epidemiology.
Division of General Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
Medicine (Baltimore). 2019 Apr;98(16):e15165. doi: 10.1097/MD.0000000000015165.
Association between heart rate (HR) and in-hospital mortality in general patients irrespective of underlying diseases were not well scrutinized. We assessed the relationship between HR on admission and in-hospital mortality among general inpatients.We used data from Japan Adverse Drug Events (JADE) study, a prospective cohort study. One tertiary care hospital in Japan with 13 medical and 12 surgical wards, and an intensive care unit (ICU). Patients (n = 2360) were ≥12 years old and admitted to this hospital within 3 months; and pregnant women were excluded. We assessed the relationship between HR and mortality in five (<60, 60-79, 80-99, 100-119, ≥120 beats per minutes [bpm]) groups. We also compared the five HR groups according to the age (<70 years; ≥70 years) and wards (medical; surgical; ICU).We enrolled 2360 patients (median age, 71 [interquartile range (IQR) 58-81] years) including 1147, 1068, and 145 patients in the medical and surgical wards, and the ICU, respectively. The median (IQR) HR on admission was 78 (68-91) bpm. Ninety-five patients died during hospitalization. Mortalities in the <60, 60-79, 80-99, 100-119, and ≥120 bpm groups were 2.9% (5/175), 2.7% (28/1047), 3.4% (26/762), 8.2% (24/291), and 14.3% (12/84), respectively (P < .001). The adjusted odds ratios of in-hospital mortality was 3.64 (95% CI 1.88-7.05, P < .001) when HR was ≥100 bpm in the medical ward; and 5.69 (95% CI 1.72-18.82, P = .004) when HR ≥120 bpm in the surgical ward. There was no statistically significant relationship with the ICU.In conclusion, higher HR should be associated with in-hospital mortality among patients with general diseases. Even with less severe condition or outside ICU, HR should be directed attention to and patients with high HR on admission should be taken additional therapy to reduce the further risk of deterioration.
无论潜在疾病如何，普通患者的心率（HR）与院内死亡率之间的关联尚未得到充分研究。我们评估了普通住院患者入院时的心率与院内死亡率之间的关系。我们使用了来自日本药物不良事件（JADE）研究的数据，这是一项前瞻性队列研究。日本一家拥有13个内科病房和12个外科病房以及一个重症监护病房（ICU）的三级护理医院。患者（n = 2360）年龄≥12岁，在3个月内入院；孕妇被排除在外。我们评估了五个心率组（<60、60 - 79、80 - 99、100 - 119、≥120次/分钟[bpm]）中心率与死亡率之间的关系。我们还根据年龄（<70岁；≥70岁）和病房（内科；外科；ICU）对这五个心率组进行了比较。我们纳入了2360名患者（中位年龄71岁[四分位间距（IQR）58 - 81岁]），其中内科病房、外科病房和ICU分别有1147名、1068名和145名患者。入院时的中位（IQR）心率为78（68 - 91）bpm。95名患者在住院期间死亡。<60、60 - 79、80 - 99、100 - 119和≥120 bpm组的死亡率分别为2.9%（5/175）、2.7%（28/1047）、3.4%（26/762）、8.2%（24/291）和14.3%（12/84）（P <.001）。在内科病房，当心率≥100 bpm时，院内死亡的调整比值比为3.64（95% CI 1.88 - 7.05，P <.001）；在外科病房，当心率≥120 bpm时，调整比值比为5.69（95% CI 1.72 - 18.82，P =.004）。与ICU无统计学显著关系。总之，较高的心率应与普通疾病患者的院内死亡率相关。即使病情较轻或在ICU之外，心率也应引起关注，入院时心率较高的患者应接受额外治疗以降低进一步恶化的风险。
