Heart rate variability for rapid risk stratification of emergency patients with malignant disease
Neoplasms are the second most common diseases in western countries. Many patients with malignant diseases repeatedly present themselves in the emergency department (ED). Due to limited capacities, appropriate risk stratification strategies for cancer patients have to be developed. This study assesses if deceleration capacity (DC) of heart rate as a parameter of heart rate variability predicts mortality in emergency patients with malignant diseases.
Prospectively, 140 adults with different entities of malignant diseases who presented in the medical ED were included. Primary and secondary endpoints were intrahospital mortality and mortality within 180 days, respectively. We calculated DC from short-term ECG readings of the surveillance monitors. Additionally, the Modified Early Warning Score (MEWS) and laboratory parameters such as white blood cells (WBC), lactate dehydrogenase, serum hemoglobin, and serum creatinine were determined.
The median age of the patients was 65 ± 14 years. 19.3% of the patients died within the hospital stay and 57.9% died within 180 days. DC and WBC were independent predictors of intrahospital death reaching a hazard ratio (HR) of 0.79 (95% confidence interval (CI) 0.63–0.993, p = 0.043) and of 1.00 (95% CI 1.00–1.00, p = 0.003), respectively. DC and serum creatinine independently predicted death within 180 days (HR 0.90, 95% CI 0.82–0.98, p = 0.023 and HR 1.41, 95% CI 1.05–1.90, p = 0.018, respectively).
Deceleration capacity of heart rate is suitable for rapid risk assessment of emergency patients with malignant diseases.
KeywordsHeart rate variability Deceleration capacity Risk prediction Cancer Malignant diseases Emergency department
Compliance with ethical standards
The study got approval from the Clinical Ethics Committee of the University Hospital Tuebingen. The need for written informed consent was waived by the ethics committee.
Conflict of interest
The authors declare that they have no conflict of interest.
- 1.Van Galen LS, Dijkstra CC, Ludikhuize J, Kramer MH, Nanayakkara PW (2016) A protocolised once a day Modified Early Warning Score (MEWS) measurement is an appropriate screening tool for major adverse events in a general hospital population. PLoS One 11(8):e0160811CrossRefPubMedPubMedCentralGoogle Scholar
- 2.Löllgen H (1999) Herzfrequenzvariabilität. Dt Ärztebl 96:A-2029–A-2032 [Heft 31–32]Google Scholar
- 7.Poreba M, Poreba R, Gac P, Usnarska-Zubkiewicz L, Pilecki W, Piotrowicz E et al (2014) Heart rate variability and heart rate turbulence in patients with hematologic malignancies subjected to high-dose chemotherapy in the course of hematopoietic stem cell transplantation. Ann Noninvasive Electrocardiol 19(2):157–165CrossRefPubMedGoogle Scholar
- 8.Ahmad S, Ramsay T, Huebsch L, Flanagan S, McDiarmid S, Batkin I, McIntyre L, Sundaresan SR, Maziak DE, Shamji FM, Hebert P, Fergusson D, Tinmouth A, Seely AJE (2009) Continuous multi-parameter heart rate variability analysis heralds onset of sepsis in adults. PLoS One 4(8):e6642CrossRefPubMedPubMedCentralGoogle Scholar
- 17.Statistisches Bundesamt. Todesursachen nach Krankheitsarten 2014. Wiesbaden 2015Google Scholar
- 21.Eick C, Rizas KD, Zuern CS, Bauer A (2014) Automated assessment of cardiac autonomic function by means of deceleration capacity from noisy, nonstationary ECG signals: validation study. Ann Noninvasive Electrocardiol: Off J Int Soc Holter Noninvasive Electrocardiol Inc 19:122–128CrossRefGoogle Scholar
- 27.Zentrum für Krebsregisterdaten. Robert Koch Institut. Verbreitung von Krebserkrankungen in Deutschland. Krebs Gesamt- Ergebnisse zur Prävalenz. S. 157Google Scholar