{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T16:17:00Z","timestamp":1777997820021,"version":"3.51.4"},"reference-count":36,"publisher":"Georg Thieme Verlag KG","issue":"09","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Thromb Haemost"],"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:p>Background\u2003Visit-to-visit heart rate variability (VVV-HR) has been associated with adverse cardiovascular outcomes. We aimed to determine the predictive value of VVV-HR for adverse clinical outcomes in patients with nonvalvular atrial fibrillation (AF).<\/jats:p><jats:p>Methods\u2003We used data from a prospective multicenter AF registry of 27 hospitals in Thailand during 2014 to 2017. After the baseline visit, patients were followed up every 6 months until 3 years. VVV-HR was calculated from the standard deviation of heart rate data from baseline visit and every follow-up visit. VVV-HR was categorized into four groups according to the quartiles. Clinical outcomes were all-cause death, ischemic stroke\/systemic embolism (SE), and heart failure. Cox proportional hazard models were used for multivariable analysis.<\/jats:p><jats:p>Results\u2003There were a total of 3,174 patients (mean age: 67.7 years; 41.8% female). The incidence rates of all-cause death, ischemic stroke\/SE, and heart failure were 3.10 (2.74\u20133.49), 1.42 (1.18\u20131.69), and 2.09 (1.80\u20132.42) per 100 person-years respectively. The average heart rate was 77.8\u2009\u00b1\u200911.0\u2009bpm and the average of standard deviation of heart rate was 11.0\u2009\u00b1\u20095.9\u2009bpm. VVV-HR Q4 was an independent predictor of all-cause death, ischemic stroke\/SE, and heart failure with adjusted hazard ratios of 1.45 (95% confidence interval: 1.07\u20131.98), 2.02 (1.24\u20133.29), and 2.63 (1.75\u20133.96), respectively. VVV-HR still remained a significant predictor of clinical outcomes when analyzed based on coefficient of variation and variability independent of mean.<\/jats:p><jats:p>Conclusion\u2003VVV-HR is an independent predictor for adverse clinical outcomes in patients with AF. A J-curve appearance was demonstrated for the effect of VVV-HR on all-cause death.<\/jats:p>","DOI":"10.1055\/s-0043-1768580","type":"journal-article","created":{"date-parts":[[2023,4,28]],"date-time":"2023-04-28T23:05:55Z","timestamp":1682723155000},"page":"920-929","source":"Crossref","is-referenced-by-count":5,"title":["Visit-to-Visit Heart Rate Variability in the Prediction of Clinical Outcomes of Patients with Atrial Fibrillation"],"prefix":"10.1055","volume":"123","author":[{"given":"Rungroj","family":"Krittayaphong","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Warangkna","family":"Boonyapisit","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Poom","family":"Sairat","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7566-1626","authenticated-orcid":false,"given":"Gregory Y. H.","family":"Lip","sequence":"additional","affiliation":[{"name":"Liverpool Centre for Cardiovascular Science, at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom"},{"name":"Department of Clinical Medicine, Aalborg University, Aalborg, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2023,4,28]]},"reference":[{"issue":"02","key":"ref1","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1177\/1747493019897870","article-title":"Global epidemiology of atrial fibrillation: an increasing epidemic and public health challenge","volume":"16","author":"G Lippi","year":"2021","journal-title":"Int J Stroke"},{"issue":"02","key":"ref2","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1093\/ehjqcco\/qcaa093","article-title":"Atrial fibrillation in the United Kingdom: predicting costs of an emerging epidemic recognising and forecasting the cost drivers of atrial fibrillation-related costs","volume":"8","author":"P Burdett","year":"2022","journal-title":"Eur Heart J Qual Care Clin Outcomes"},{"issue":"15","key":"ref3","doi-asserted-by":"crossref","first-page":"3357","DOI":"10.3390\/jcm10153357","article-title":"Prediction of residual stroke risk in anticoagulated patients with atrial fibrillation: mCARS","volume":"10","author":"W Y Ding","year":"2021","journal-title":"J Clin Med"},{"issue":"03","key":"ref4","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1055\/s-0040-1716408","article-title":"The 4S-AF Scheme (Stroke Risk; Symptoms; Severity of Burden; Substrate): a novel approach to in-depth characterization (rather than classification) of atrial fibrillation","volume":"121","author":"T S Potpara","year":"2021","journal-title":"Thromb Haemost"},{"issue":"11","key":"ref5","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1038\/nrcardio.2017.153","article-title":"The ABC pathway: an integrated approach to improve AF management","volume":"14","author":"G YH Lip","year":"2017","journal-title":"Nat Rev Cardiol"},{"issue":"05","key":"ref6","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1093\/eurheartj\/ehaa612","article-title":"2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC","volume":"42","author":"G Hindricks","year":"2021","journal-title":"Eur Heart J"},{"issue":"05","key":"ref7","doi-asserted-by":"crossref","first-page":"1121","DOI":"10.1016\/j.chest.2018.07.040","article-title":"Antithrombotic therapy for atrial fibrillation: CHEST guideline and expert panel report","volume":"154","author":"G YH Lip","year":"2018","journal-title":"Chest"},{"issue":"01","key":"ref8","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1055\/s-0041-1739411","article-title":"2021 Focused update consensus guidelines of the Asia Pacific Heart Rhythm Society on stroke prevention in atrial fibrillation: executive summary","volume":"122","author":"T F Chao","year":"2022","journal-title":"Thromb Haemost"},{"issue":"03","key":"ref9","first-page":"406","article-title":"Adherence to the \u2018Atrial Fibrillation Better Care\u2019 pathway in patients with atrial fibrillation: impact on clinical outcomes-a systematic review and meta-analysis of 285,000 patients","volume":"122","author":"G F Romiti","year":"2021","journal-title":"Thromb Haemost"},{"issue":"01","key":"ref10","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1093\/europace\/euac062","article-title":"Early diagnosis and better rhythm management to improve outcomes in patients with atrial fibrillation: the 8th AFNET\/EHRA consensus conference","volume":"25","author":"R B Schnabel","year":"2023","journal-title":"Europace"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"829","DOI":"10.1016\/S0140-6736(16)31277-6","article-title":"Rhythm control in atrial fibrillation","volume":"388","author":"J P Piccini","year":"2016","journal-title":"Lancet"},{"issue":"15","key":"ref12","doi-asserted-by":"crossref","first-page":"1363","DOI":"10.1056\/NEJMoa1001337","article-title":"Lenient versus strict rate control in patients with atrial fibrillation","volume":"362","author":"I C Van Gelder","year":"2010","journal-title":"N Engl J Med"},{"issue":"02","key":"ref13","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1046\/j.1532-5415.2003.51080.x","article-title":"Resting heart rate in older people: a predictor of survival to age 85","volume":"51","author":"A Benetos","year":"2003","journal-title":"J Am Geriatr Soc"},{"key":"ref14","doi-asserted-by":"crossref","first-page":"c2289","DOI":"10.1136\/bmj.c2289","article-title":"Random measurement error and regression dilution bias","volume":"340","author":"J A Hutcheon","year":"2010","journal-title":"BMJ"},{"key":"ref15","doi-asserted-by":"crossref","first-page":"850223","DOI":"10.3389\/fcvm.2022.850223","article-title":"Visit-to-visit heart rate variability is positively associated with the risk of adverse cardiovascular outcomes","volume":"9","author":"R Zeng","year":"2022","journal-title":"Front Cardiovasc Med"},{"issue":"01","key":"ref16","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.atherosclerosis.2010.01.029","article-title":"Elevated heart rate and cardiovascular outcomes in patients with coronary artery disease: clinical evidence and pathophysiological mechanisms","volume":"212","author":"C C Lang","year":"2010","journal-title":"Atherosclerosis"},{"key":"ref17","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/j.amjcard.2021.06.009","article-title":"Frequency of visit-to-visit variability of resting heart rate and the risk of new-onset atrial fibrillation in the general population","volume":"155","author":"S Zhang","year":"2021","journal-title":"Am J Cardiol"},{"issue":"03","key":"ref18","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1161\/HYPERTENSIONAHA.113.01426","article-title":"Impact of atrial fibrillation on the accuracy of oscillometric blood pressure monitoring","volume":"62","author":"N Pagonas","year":"2013","journal-title":"Hypertension"},{"issue":"04","key":"ref19","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1016\/j.jacc.2014.12.018","article-title":"2014 ACC\/AHA key data elements and definitions for cardiovascular endpoint events in clinical trials: a report of the American College of Cardiology\/American Heart Association Task Force on Clinical Data Standards (Writing Committee to Develop Cardiovascular Endpoints Data Standards)","volume":"66","author":"K A Hicks","year":"2015","journal-title":"J Am Coll Cardiol"},{"issue":"06","key":"ref20","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1161\/CIRCULATIONAHA.115.017719","article-title":"Introduction to the analysis of survival data in the presence of competing risks","volume":"133","author":"P C Austin","year":"2016","journal-title":"Circulation"},{"issue":"04","key":"ref21","doi-asserted-by":"crossref","first-page":"675","DOI":"10.1038\/s41409-019-0679-x","article-title":"Cubic splines to model relationships between continuous variables and outcomes: a guide for clinicians","volume":"55","author":"J Gauthier","year":"2020","journal-title":"Bone Marrow Transplant"},{"issue":"38","key":"ref22","doi-asserted-by":"crossref","first-page":"2882","DOI":"10.1093\/eurheartj\/ehw233","article-title":"Two-year outcomes of patients with newly diagnosed atrial fibrillation: results from GARFIELD-AF","volume":"37","author":"J P Bassand","year":"2016","journal-title":"Eur Heart J"},{"issue":"10","key":"ref23","doi-asserted-by":"crossref","first-page":"1403","DOI":"10.1253\/circj.CJ-17-0071","article-title":"Sex-related differences in the clinical events of patients with atrial fibrillation - the Fushimi AF Registry","volume":"81","author":"H Ogawa","year":"2017","journal-title":"Circ J"},{"issue":"02","key":"ref24","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1093\/europace\/euaa274","article-title":"Relation of outcomes to ABC (Atrial Fibrillation Better Care) pathway adherent care in European patients with atrial fibrillation: an analysis from the ESC-EHRA EORP Atrial Fibrillation General Long-Term (AFGen LT) Registry","volume":"23","author":"M Proietti","year":"2021","journal-title":"Europace"},{"issue":"13","key":"ref25","doi-asserted-by":"crossref","first-page":"1523","DOI":"10.1016\/j.jacc.2020.01.052","article-title":"Mobile health technology to improve care for patients with atrial fibrillation","volume":"75","author":"Y Guo","year":"2020","journal-title":"J Am Coll Cardiol"},{"issue":"04","key":"ref26","doi-asserted-by":"crossref","first-page":"1280","DOI":"10.1161\/HYPERTENSIONAHA.119.14553","article-title":"Visit-to-visit blood pressure variability is associated with cognitive decline and incident dementia: the S.AGES cohort","volume":"76","author":"L Rouch","year":"2020","journal-title":"Hypertension"},{"issue":"01","key":"ref27","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1016\/j.jacc.2019.01.011","article-title":"2019 AHA\/ACC\/HRS Focused Update of the 2014 AHA\/ACC\/HRS Guideline for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology\/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society","volume":"74","author":"C T January","year":"2019","journal-title":"J Am Coll Cardiol"},{"issue":"17","key":"ref28","doi-asserted-by":"crossref","first-page":"1604","DOI":"10.1161\/CIRCULATIONAHA.114.013709","article-title":"Rate-control treatment and mortality in atrial fibrillation","volume":"132","author":"T F Chao","year":"2015","journal-title":"Circulation"},{"issue":"28","key":"ref29","doi-asserted-by":"crossref","first-page":"1831","DOI":"10.1093\/eurheartj\/ehv143","article-title":"Digoxin-associated mortality: a systematic review and meta-analysis of the literature","volume":"36","author":"M Vamos","year":"2015","journal-title":"Eur Heart J"},{"issue":"11","key":"ref30","doi-asserted-by":"crossref","first-page":"894","DOI":"10.1136\/heartjnl-2014-307043","article-title":"Heart rate is associated with progression of atrial fibrillation, independent of rhythm","volume":"101","author":"F Holmqvist","year":"2015","journal-title":"Heart"},{"issue":"01","key":"ref31","doi-asserted-by":"crossref","first-page":"e13361","DOI":"10.1111\/eci.13361","article-title":"Heart rate variability in patients with atrial fibrillation and hypertension","volume":"51","author":"A A Khan","year":"2021","journal-title":"Eur J Clin Invest"},{"issue":"11","key":"ref32","doi-asserted-by":"crossref","first-page":"669","DOI":"10.1093\/eurheartj\/ehu401","article-title":"Prognostic importance of temporal changes in resting heart rate in heart failure patients: an analysis of the CHARM program","volume":"36","author":"A Vazir","year":"2015","journal-title":"Eur Heart J"},{"issue":"02","key":"ref33","doi-asserted-by":"crossref","first-page":"e002160","DOI":"10.1161\/JAHA.115.002160","article-title":"Effect of visit-to-visit variation of heart rate and systolic blood pressure on outcomes in chronic systolic heart failure: results from the Systolic Heart Failure Treatment With the If Inhibitor Ivabradine Trial (SHIFT) trial","volume":"5","author":"M B\u00f6hm","year":"2016","journal-title":"J Am Heart Assoc"},{"issue":"11","key":"ref34","doi-asserted-by":"crossref","first-page":"e13174","DOI":"10.1111\/eci.13174","article-title":"Heart rate variability in atrial fibrillation: the balance between sympathetic and parasympathetic nervous system","volume":"49","author":"A A Khan","year":"2019","journal-title":"Eur J Clin Invest"},{"issue":"01","key":"ref35","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1161\/HYPERTENSIONAHA.115.06960","article-title":"The association between antihypertensive medication nonadherence and visit-to-visit variability of blood pressure: findings from the antihypertensive and lipid-lowering treatment to prevent heart attack trial","volume":"68","author":"I M Kronish","year":"2016","journal-title":"Hypertension"},{"issue":"05","key":"ref36","doi-asserted-by":"crossref","first-page":"949","DOI":"10.1161\/HYPERTENSIONAHA.117.10106","article-title":"Systolic blood pressure visit-to-visit variability and major adverse outcomes in atrial fibrillation: the AFFIRM study (Atrial Fibrillation Follow-Up Investigation of Rhythm Management)","volume":"70","author":"M Proietti","year":"2017","journal-title":"Hypertension"}],"container-title":["Thrombosis and Haemostasis"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0043-1768580.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,12,11]],"date-time":"2023-12-11T18:48:45Z","timestamp":1702320525000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0043-1768580"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,4,28]]},"references-count":36,"journal-issue":{"issue":"09","published-online":{"date-parts":[[2023,8,28]]},"published-print":{"date-parts":[[2023,9]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0043-1768580","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0340-6245","2567-689X"],"issn-type":[{"value":"0340-6245","type":"print"},{"value":"2567-689X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,4,28]]}}}