Ernst Gernot, Watne Leiv Otto, Frihagen Frede, Wyller Torgeier Bruun, Dominik Andreas, Rostrup Morten
Department of Anesthesiology, Kongsberg Hospital, Kongsberg, Norway.
Section of Cardiovascular and Renal Research, University of Oslo, Oslo, Norway.
Front Cardiovasc Med. 2021 Mar 22;8:640970. doi: 10.3389/fcvm.2021.640970. eCollection 2021.
One-year mortality after hip fractures is underestimated and is reported as 25%. An improved risk stratifying could contribute to a better follow up of these patients. Heart Rate Variability (HRV) is an easy point-of-care investigation and is been used in cardiology, endocrinology, and perioperative care. This observational study intended to explore relevant associations between HRV parameters and 6-months mortality and morbidity after a hip fracture. One hundred and sixty-five patients admitted to two hospitals were included, and short-time HRV measurements (5 min, and 10 min at the two hospitals, respectively) were obtained. Mortality data were gathered by means of the Norwegian central address register. Patients, close relatives of patients, and in some cases their general physicians or nursery home physicians were interviewed 6 months postoperatively regarding the incidence of pneumonia, cardiac events, or stroke. One and hundred fifty-seven (95.2%) patients were followed up after 6 months post-surgery. Twenty-one (13%) died during this period. Twenty patients (13%) developed pneumonia, eight (5 %) stroke, and four (2%) myocardial infarction. No HRV parameter was associated with 6-month general mortality. However, patients who developed stroke had significantly lower High Frequency Power (HF, < 0.001) and lower Very Low Frequency Power (VLF, = 0.003) at inclusion compared to patients without complications. Patients who developed pneumonia had at the inclusion lower root mean square of successive differences (RMSSD, = 0.044). Patients with a history of coronary heart disease ( = 41) showed a mortality of 7%. Mortality in this group was associated with standard deviation of beat-to-beat intervals (SDNN, = 0.006), Total Power (TP, = 0.009), HF ( = 0.026), and Low Frequency Power (LF, = 0.012). Beta-blocker intake was associated with lower heart rate, but not with differences in HRV parameters. In this exploratory study, we present for the first-time significant associations between different preoperative HRV parameters and stroke, myocardial infarction, and pneumonia during a 6-month period after hip fracture. HRV might be a simple and effective tool to identify patients at risk that would warrant better follow-up.
髋部骨折后的一年死亡率被低估，报告为25%。改进风险分层有助于更好地随访这些患者。心率变异性（HRV）是一种简单的即时护理检查方法，已应用于心脏病学、内分泌学和围手术期护理。这项观察性研究旨在探讨HRV参数与髋部骨折后6个月死亡率和发病率之间的相关联系。纳入了两家医院收治的165例患者，并分别在两家医院进行了短时间HRV测量（5分钟和10分钟）。通过挪威中央地址登记处收集死亡率数据。术后6个月对患者、患者近亲，在某些情况下还对他们的全科医生或养老院医生进行访谈，了解肺炎、心脏事件或中风的发生率。术后6个月对157例（95.2%）患者进行了随访。在此期间，21例（13%）死亡。20例（13%）发生肺炎，8例（5%）中风，4例（2%）心肌梗死。没有HRV参数与6个月总体死亡率相关。然而，与无并发症患者相比，发生中风的患者在纳入时高频功率（HF，<0.001）和极低频功率（VLF，=0.003）显著更低。发生肺炎的患者在纳入时逐搏间期的均方根（RMSSD，=0.044）更低。有冠心病病史的患者（=41）死亡率为7%。该组死亡率与逐搏间期标准差（SDNN，=0.006）、总功率（TP，=0.009）、HF（=0.026）和低频功率（LF，=0.012）相关。服用β受体阻滞剂与心率降低有关，但与HRV参数差异无关。在这项探索性研究中，我们首次呈现了髋部骨折后6个月内不同术前HRV参数与中风、心肌梗死和肺炎之间的显著关联。HRV可能是一种简单有效的工具，用于识别有风险的患者，从而有必要进行更好的随访。
