Dynamic changes in nocturnal heart rate predict short-term cardiovascular events in patients using the wearable cardioverter-defibrillator: from the WEARIT-France cohort study
Authors: Garcia Rodrigue , Warming Peder Emil , Narayanan Kumar , Defaye Pascal , Guedon-Moreau Laurence , Blangy Hugues , Piot Olivier , Leclercq Christophe , Marijon Eloi ,   the WEARIT-France Investigators, Moreau Laurence Guedon , Mahfoud Mohanad , Ritter Philippe , Dupuis Jean Marc , Yalioua Arab , Dompnier Antoine , Goralski Marc , Cheggour Saïda , Leclercq Christophe , Marijon Eloi , Bouet Jérôme , André Clémentine , Extramiana Fabrice , Briand Florent , Rollin Anne , Lande Gilles , Chevalier Philippe , Pasquié Jean-Luc , Lellouche Nicolas , Degand Bruno , Cottin Yves , Jourda François , Mansourati Jacques , Martin Angeline , Da Costa Antoine , Billon Olivier , Cheradame Isabelle , Hermida Jean-Sylvain , Bayard Julien , Eschalier Romain , Moyat Benoit Guy , Manenti Vladimir , Gorka Hervé , Combes Nicolas , Milhem Antoine , Piot Olivier , Guyomar Yves , Fouché Renaud , Litoux Elisabeth Somody , Quentin Anne , Berneau Jean Baptiste , Tibi Thierry , Miralles Aurélien , Salerno Fiorella , Jacon Peggy , Nitu Laurentin , Brunet Damien , Bader Hugues , Savoure Arnaud , Sagnol Pascal , Sebag Frédéric , Buffler Sebastien , Fedida Joël , Pineau Julien , De Geeter Guillaume , Zemmoura Adlane , Salhi Ahmed , Verbrugge Eric , Pynn Sophie , Gueffet Jean Pierre , Amara Walid , Seemann Aurélien , Winum Pierre , Johnson Nicolas , Vanesson Claire , Mechulan Alexis , Hugon Vincent , Marchand Xavier , Deharo Jean-Claude , Reuter Sylvain , Sandras Raphael , Legalloi Damien , Garrier Olivier , Jauvert Gaël , Descoux Jérémy , Blangy Hugues , Lebon Alain , Sultan Pierre , Sibellas Franck , Mousi Samer , Laurent Gabriel , Pons Maxime , Marzak Halim , Clerc Jérôme , Barake Hassan , Guiot Aurélie , Algalarrondo Vincent , Palud Laurent , Raguin Denis , Treguer Frédéric , Le Franc Pierre , Lecardonnel Isabelle , Fossati Frederic , Moubarak Ghassan , Mokrani Omar Bilel , Chavernac Pascal 
Published: April 2023

Abstract

Aims
While elevated resting heart rate measured at a single point of time has been associated with cardiovascular outcomes, utility of continuous monitoring of nocturnal heart rate (NHR) has never been evaluated. We hypothesized that dynamic NHR changes may predict, at short term, impending cardiovascular events in patients equipped with a wearable cardioverter-defibrillator (WCD).

Methods and results
The WEARIT-France prospective cohort study enrolled heart failure patients with WCD between 2014 and 2018. Night-time was defined as midnight to 7 a.m. NHR initial trajectories were classified into four categories based on mean NHR in the first week (High/Low) and NHR evolution over the second week (Up/Down) of WCD use. The primary endpoint was a composite of cardiovascular death and heart failure hospitalization. A total of 1013 [61 (interquartile range, IQR 53–68) years, 16% women, left ventricular ejection fraction 26% (IQR 22–30)] were included. During a median WCD wear duration of 68 (IQR 44–90) days, 58 patients (6%) experienced 69 events. After considering potential confounders, High-Up NHR trajectory was significantly associated with the primary endpoint compared to Low-Down [adjusted hazard ratio (HR) 6.08, 95% confidence interval (CI) 2.56–14.45, P &lt; 0.001]. Additionally, a rise of &gt;5 bpm in weekly average NHR from the preceding week was associated with 2.5 higher composite event risk (HR 2.51, 95% CI 1.22–5.18, P = 0.012) as well as total mortality (HR 11.21, 95% CI 3.55–35.37, P &lt; 0.001) and cardiovascular hospitalization (HR 2.70, 95% CI 1.51–4.82, P &lt; 0.001).

Conclusion
Dynamic monitoring of NHR may allow timely identification of impending cardiovascular events, with the potential for ‘pre-emptive’ action.

Registration number
Clinical Trials.gov Identifier: NCT03319160