Physiological Complexity Underlying Heart Rate Dynamics and Frailty Status in Community-Dwelling Older Women

Authors

  • Paulo H. M. Chaves MD, PhD,

    1. From the aCenter on Aging and Health, bDivision of Geriatrics Medicine and Gerontology, and Departments of, cMedicine and dEpidemiology, Johns Hopkins University, Baltimore, MarylandeUNATI Center for Studies on Aging and Care of the Elderly, Rio de Janeiro State University, Rio de Janeiro, RJ, BrazilfBeth Israel Deaconess Medical Center, Harvard Medical School, Boston, MassachusettsgDepartment of Geriatric Medicine, Hebrew SeniorLife, Boston, MassachusettshSchool of Medicine, Washington University, St. Louis, MissouriiLongitudinal Studies Section, Clinical Research Branch, National Institute on Aging, Baltimore, MarylandjDepartment of Anesthesiology and Critical Care, University of Pennsylvania School of Medicine, Philadelphia, PennsylvaniakLaboratory of Epidemiology, Demography, and Biometry; National Institute on Aging, Bethesda, MarylandlMailman School of Public Health, Columbia University, New York, New York.
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  • a,b,c,d,e Ravi Varadhan PhD,

    1. From the aCenter on Aging and Health, bDivision of Geriatrics Medicine and Gerontology, and Departments of, cMedicine and dEpidemiology, Johns Hopkins University, Baltimore, MarylandeUNATI Center for Studies on Aging and Care of the Elderly, Rio de Janeiro State University, Rio de Janeiro, RJ, BrazilfBeth Israel Deaconess Medical Center, Harvard Medical School, Boston, MassachusettsgDepartment of Geriatric Medicine, Hebrew SeniorLife, Boston, MassachusettshSchool of Medicine, Washington University, St. Louis, MissouriiLongitudinal Studies Section, Clinical Research Branch, National Institute on Aging, Baltimore, MarylandjDepartment of Anesthesiology and Critical Care, University of Pennsylvania School of Medicine, Philadelphia, PennsylvaniakLaboratory of Epidemiology, Demography, and Biometry; National Institute on Aging, Bethesda, MarylandlMailman School of Public Health, Columbia University, New York, New York.
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  • a,b,c Lewis A. Lipsitz MD,

    1. From the aCenter on Aging and Health, bDivision of Geriatrics Medicine and Gerontology, and Departments of, cMedicine and dEpidemiology, Johns Hopkins University, Baltimore, MarylandeUNATI Center for Studies on Aging and Care of the Elderly, Rio de Janeiro State University, Rio de Janeiro, RJ, BrazilfBeth Israel Deaconess Medical Center, Harvard Medical School, Boston, MassachusettsgDepartment of Geriatric Medicine, Hebrew SeniorLife, Boston, MassachusettshSchool of Medicine, Washington University, St. Louis, MissouriiLongitudinal Studies Section, Clinical Research Branch, National Institute on Aging, Baltimore, MarylandjDepartment of Anesthesiology and Critical Care, University of Pennsylvania School of Medicine, Philadelphia, PennsylvaniakLaboratory of Epidemiology, Demography, and Biometry; National Institute on Aging, Bethesda, MarylandlMailman School of Public Health, Columbia University, New York, New York.
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  • f,g Phyllis K. Stein PhD,

    1. From the aCenter on Aging and Health, bDivision of Geriatrics Medicine and Gerontology, and Departments of, cMedicine and dEpidemiology, Johns Hopkins University, Baltimore, MarylandeUNATI Center for Studies on Aging and Care of the Elderly, Rio de Janeiro State University, Rio de Janeiro, RJ, BrazilfBeth Israel Deaconess Medical Center, Harvard Medical School, Boston, MassachusettsgDepartment of Geriatric Medicine, Hebrew SeniorLife, Boston, MassachusettshSchool of Medicine, Washington University, St. Louis, MissouriiLongitudinal Studies Section, Clinical Research Branch, National Institute on Aging, Baltimore, MarylandjDepartment of Anesthesiology and Critical Care, University of Pennsylvania School of Medicine, Philadelphia, PennsylvaniakLaboratory of Epidemiology, Demography, and Biometry; National Institute on Aging, Bethesda, MarylandlMailman School of Public Health, Columbia University, New York, New York.
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  • h B. Gwen Windham MD, MHS,

    1. From the aCenter on Aging and Health, bDivision of Geriatrics Medicine and Gerontology, and Departments of, cMedicine and dEpidemiology, Johns Hopkins University, Baltimore, MarylandeUNATI Center for Studies on Aging and Care of the Elderly, Rio de Janeiro State University, Rio de Janeiro, RJ, BrazilfBeth Israel Deaconess Medical Center, Harvard Medical School, Boston, MassachusettsgDepartment of Geriatric Medicine, Hebrew SeniorLife, Boston, MassachusettshSchool of Medicine, Washington University, St. Louis, MissouriiLongitudinal Studies Section, Clinical Research Branch, National Institute on Aging, Baltimore, MarylandjDepartment of Anesthesiology and Critical Care, University of Pennsylvania School of Medicine, Philadelphia, PennsylvaniakLaboratory of Epidemiology, Demography, and Biometry; National Institute on Aging, Bethesda, MarylandlMailman School of Public Health, Columbia University, New York, New York.
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  • i Jing Tian MHS,

    1. From the aCenter on Aging and Health, bDivision of Geriatrics Medicine and Gerontology, and Departments of, cMedicine and dEpidemiology, Johns Hopkins University, Baltimore, MarylandeUNATI Center for Studies on Aging and Care of the Elderly, Rio de Janeiro State University, Rio de Janeiro, RJ, BrazilfBeth Israel Deaconess Medical Center, Harvard Medical School, Boston, MassachusettsgDepartment of Geriatric Medicine, Hebrew SeniorLife, Boston, MassachusettshSchool of Medicine, Washington University, St. Louis, MissouriiLongitudinal Studies Section, Clinical Research Branch, National Institute on Aging, Baltimore, MarylandjDepartment of Anesthesiology and Critical Care, University of Pennsylvania School of Medicine, Philadelphia, PennsylvaniakLaboratory of Epidemiology, Demography, and Biometry; National Institute on Aging, Bethesda, MarylandlMailman School of Public Health, Columbia University, New York, New York.
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  • a,b,c Lee A. Fleisher MD,

    1. From the aCenter on Aging and Health, bDivision of Geriatrics Medicine and Gerontology, and Departments of, cMedicine and dEpidemiology, Johns Hopkins University, Baltimore, MarylandeUNATI Center for Studies on Aging and Care of the Elderly, Rio de Janeiro State University, Rio de Janeiro, RJ, BrazilfBeth Israel Deaconess Medical Center, Harvard Medical School, Boston, MassachusettsgDepartment of Geriatric Medicine, Hebrew SeniorLife, Boston, MassachusettshSchool of Medicine, Washington University, St. Louis, MissouriiLongitudinal Studies Section, Clinical Research Branch, National Institute on Aging, Baltimore, MarylandjDepartment of Anesthesiology and Critical Care, University of Pennsylvania School of Medicine, Philadelphia, PennsylvaniakLaboratory of Epidemiology, Demography, and Biometry; National Institute on Aging, Bethesda, MarylandlMailman School of Public Health, Columbia University, New York, New York.
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  • j Jack M. Guralnik MD, PhD,

    1. From the aCenter on Aging and Health, bDivision of Geriatrics Medicine and Gerontology, and Departments of, cMedicine and dEpidemiology, Johns Hopkins University, Baltimore, MarylandeUNATI Center for Studies on Aging and Care of the Elderly, Rio de Janeiro State University, Rio de Janeiro, RJ, BrazilfBeth Israel Deaconess Medical Center, Harvard Medical School, Boston, MassachusettsgDepartment of Geriatric Medicine, Hebrew SeniorLife, Boston, MassachusettshSchool of Medicine, Washington University, St. Louis, MissouriiLongitudinal Studies Section, Clinical Research Branch, National Institute on Aging, Baltimore, MarylandjDepartment of Anesthesiology and Critical Care, University of Pennsylvania School of Medicine, Philadelphia, PennsylvaniakLaboratory of Epidemiology, Demography, and Biometry; National Institute on Aging, Bethesda, MarylandlMailman School of Public Health, Columbia University, New York, New York.
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  • and k Linda P. Fried MD, MPH l

    1. From the aCenter on Aging and Health, bDivision of Geriatrics Medicine and Gerontology, and Departments of, cMedicine and dEpidemiology, Johns Hopkins University, Baltimore, MarylandeUNATI Center for Studies on Aging and Care of the Elderly, Rio de Janeiro State University, Rio de Janeiro, RJ, BrazilfBeth Israel Deaconess Medical Center, Harvard Medical School, Boston, MassachusettsgDepartment of Geriatric Medicine, Hebrew SeniorLife, Boston, MassachusettshSchool of Medicine, Washington University, St. Louis, MissouriiLongitudinal Studies Section, Clinical Research Branch, National Institute on Aging, Baltimore, MarylandjDepartment of Anesthesiology and Critical Care, University of Pennsylvania School of Medicine, Philadelphia, PennsylvaniakLaboratory of Epidemiology, Demography, and Biometry; National Institute on Aging, Bethesda, MarylandlMailman School of Public Health, Columbia University, New York, New York.
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Address correspondence to Paulo H. M. Chaves, MD, PhD, Johns Hopkins Center on Aging and Health, 2024 E. Monument Street, Suite 2-700, Baltimore, MD 21205. E-mail: pchaves@jhsph.edu

Abstract

OBJECTIVES: To assess whether less physiological complexity underlying regulation of heart rate dynamics, as indicated by lower approximate entropy for heart rate (ApEnHR), is associated with frailty. For supporting validity, relationships between frailty and traditional linear indices of heart rate variability (HRV) were also assessed.

DESIGN: Cross-sectional.

SETTING: Women's Health and Aging Study I, a community-based observational study, 1992 to 1995.

PARTICIPANTS: Subset of 389 community-dwelling women aged years and older with moderate to severe disability with ApEnHR data (convenience sampling).

MEASUREMENTS: Electrocardiographic Holter recordings obtained over 2- to 3-hour periods were processed for ApEnHR and HRV measures. ApEnHR is a nonlinear statistic that quantifies the regularity of heart rate fluctuations over time. Lower ApEnHR is characteristic of heart rate time series containing a high proportion of repetitive patterns. Frailty was defined according to validated phenotype criteria.

RESULTS: Median ApEnHR was lower in frail than in nonfrail subjects (P=.02). Lower ApEnHR (top quartile) was associated with lower likelihood of frailty than higher ApEnHR (bottom three quartiles) (odds ratio=0.47, 95% confidence interval=0.26–0.86), even after adjustment for major confounders. Frailty was consistently associated with lower HRV as assessed using time- and frequency-domain indices.

CONCLUSION: This study supports the notion that less physiological complexity marks frailty and provides an empirical basis to the concept of frailty as a syndrome of homeostatic impairment. Future research will determine whether noninvasive measures of physiological complexity underlying heart rate dynamics might be useful for screening and monitoring of clinical vulnerability in older adults.

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