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Abstract Number: 1593

Heart Rate Visit-to-Visit Variability in Patients with Systemic Lupus Erythematosus Is Associated with Increased Mortality

Tyler Reese1, Alyson Dickson 1, Jocelyn Gandelman 1, Sarah Bayefsky 1, April Barnado 1, Katherine Barker 1, C. Michael Stein 1, Vivian Kawai 1 and Cecilia Chung 1, 1Vanderbilt University Medical Center, Nashville, TN

Meeting: 2019 ACR/ARP Annual Meeting

Keywords: cardiovascular disease and death, Lupus, SLE

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Session Information

Date: Monday, November 11, 2019

Session Title: SLE – Clinical Poster II: Comorbidities

Session Type: Poster Session (Monday)

Session Time: 9:00AM-11:00AM

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.


Disclosure: T. Reese, Rheumatology Research Foundation, 2; A. Dickson, None; J. Gandelman, None; S. Bayefsky, Rheumatology Research Foundation, 2; A. Barnado, NIH/NIAMS 5K08AR072757-02, 2; K. Barker, None; C. Stein, None; V. Kawai, NIH K23GM117395, 2, NIH NIGMS K23GM117395, 2, NIH/NIGMS K23GM117395, 2, NIH, 2, NIH, 2; C. Chung, Lupus Research Alliance, 2, NCATS/NIH CTSA grant ULTR000445, 2, Rheumatology Research Foundation, 2, Veterans Health Administration CDA, 2.

To cite this abstract in AMA style:

Reese T, Dickson A, Gandelman J, Bayefsky S, Barnado A, Barker K, Stein C, Kawai V, Chung C. Heart Rate Visit-to-Visit Variability in Patients with Systemic Lupus Erythematosus Is Associated with Increased Mortality [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). https://acrabstracts.org/abstract/heart-rate-visit-to-visit-variability-in-patients-with-systemic-lupus-erythematosus-is-associated-with-increased-mortality/. Accessed April 17, 2021.
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