Association of heart rate recovery with mortality risk in a 72-month survival analysis

This study aimed to investigate whether heart rate recovery (HRR) is a predictor of all-cause mortality in a 72-month survival analysis. In this cohort study, 578 individuals who underwent a maximal exercise test at a university hospital between August 2012 and August 2018 were followed for up to 72 months. Participants performed a maximal incremental treadmill test, followed by an active recovery period phase to evaluate their HRR. When the decay of heart rate totaled ≥ 13bpm in the first minute post-exercise a normal HRR was considered, whereas an abnormal HRR was defined as ≤ 12bpm. Of the 578 individuals, 371 (64.2%) had normal HRR, whereas 207 (35.8%) had an abnormal HRR. The survival analysis showed significantly higher 72-month survival in the normal HRR group (93.8%) than in the abnormal HRR group (81.6%), with a 3.16 hazard ratio (95%CI: 1.86-5.35). Individuals with abnormal HRR were generally older, had a greater burden of comorbidities, shorter time to exhaustion, lower peak heart rate, and higher heart rate 60 seconds after the exercise. Thus, HRR predicted 72-month all-cause mortality. These findings suggest the use of HRR as a simple, non-invasive prognostic tool in clinical practice, particularly for stratifying mortality risk.