Background/Purpose: Patients with systemic lupus erythematosus (SLE) have increased mortality compared to the general population. Heart rate visit-to-visit variability (HRVVV) has emerged as an adverse risk factor for long-term outcomes, particularly in patients with cardiovascular disease. SLE patients represent a high-risk population for cardiovascular disease; however, the relationship between HRVVV and all-cause mortality in patients with SLE has not been examined. We studied the association between increased HR visit-to-visit variability and all-cause mortality in patients with SLE.

Methods: We identified a cohort of patients with SLE using a previously validated algorithm (PPV 94%) from a de-identified version of an academic medical center’s electronic health record that contains more than 2.8 million patients. Demographic variables (age, race, and sex), ICD9 codes, laboratory results, and HR measures were extracted. We excluded HR measures from inpatient admissions or emergency department visits, measures for individuals under 18, measures < 40 or >140 beats per minute, and individuals with fewer than three outpatient measures. HR variability was defined as the intraindividual standard deviation of all qualifying measures. The primary outcome was all-cause mortality with incident rate ratios (IRR) calculated using Poisson regression.

Results: A total of 687 patients with SLE met our inclusion criteria with 16,981 heart rate measures. The median intraindividual standard deviation was 12.1 (mean 12.51 ± 4.05). HRVVV correlated significantly with age and creatinine, but not with C-reactive protein, C3, C4, nor body mass index (Table 1). Over a median follow-up of 5.7 years, 66 patients died. One SD of HRVVV was associated with a higher risk of mortality (IRR: 1.10 95% CI: 1.06-1.15, p< 0.001). After adjustment for age, sex, race, and baseline Charlson comorbidity score, the association between HR variability and increased mortality remained significant (IRR: 1.14, 95% C.I.: 1.09-1.19, Table 2).

Conclusion: In patients with SLE, higher heart rate visit-to-visit variability was associated with increased mortality independent of age, sex, race, and baseline comorbidities.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/heart-rate-visit-to-visit-variability-in-patients-with-systemic-lupus-erythematosus-is-associated-with-increased-mortality/