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

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...

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Bibliographic Details
Published in:Journal of the American Geriatrics Society (JAGS) 2008-09, Vol.56 (9), p.1698-1703
Main Authors: Chaves, Paulo H. M., Varadhan, Ravi, Lipsitz, Lewis A., Stein, Phyllis K., Windham, B. Gwen, Tian, Jing, Fleisher, Lee A., Guralnik, Jack M., Fried, Linda P.
Format: Article
Language:English
Subjects:
Activities of Daily Living
Aged
Aged, 80 and over
Anatomy & physiology
approximate entropy
Baltimore
Biological and medical sciences
Comorbidity
Coronary Disease - diagnosis
Coronary Disease - epidemiology
Coronary Disease - physiopathology
Cross-Sectional Studies
Diabetes Mellitus - diagnosis
Diabetes Mellitus - epidemiology
Diabetes Mellitus - physiopathology
Disability Evaluation
elderly
Electrocardiography, Ambulatory
Entropy
Female
Frail Elderly
Frailty
General aspects
Geriatric Assessment
Geriatrics
Heart Failure - diagnosis
Heart Failure - epidemiology
Heart Failure - physiopathology
Heart rate
Heart Rate - physiology
heart rate variability
Homeostasis - physiology
Humans
Likelihood Functions
Mass Screening
Medical sciences
Miscellaneous
Older people
Physical fitness
physiological complexity
Public health. Hygiene
Public health. Hygiene-occupational medicine
Women
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Summary: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.
ISSN:0002-8614
1532-5415
DOI:10.1111/j.1532-5415.2008.01858.x