Background: Peak oxygen uptake (peak VO2) has been known to be a strong predictor of mortality. Reduced heart rate recovery (HRR) has also been shown to predict mortality. However, little is known about the significance of reduced HRR in elderly patients with chronic heart failure (CHF). Methods and Results: We evaluated 152 elderly patients with CHF (mean age 73 ± 5.4 years, 82% men) who in cardiac rehabilitation program and underwent cardiopulmonary exercise testing between April 2013 and March 2016. HRR1 was defined as the difference in heart rate between peak exercise and 1 minute later; a value less than or equal to 12 beats per minute was considered abnormal. All cause of death and hospitalization due to cardiovascular events were followed up as the primary end points (adverse events). Of 152 patients, 35 had an abnormal HRR1. Among patients with an abnormal HRR1, four were hospitalized. None of the patients with a normal HRR1 died or was hospitalized (P < .05). Multivariate analysis demonstrated that peak VO2 and an abnormal HRR1 were predictors of adverse events, suggesting importance of exercise capacity and cardiac parasympathetic activity. Conclusions: Reduced HRR1 could be a predictor of adverse events in elderly CHF patients who participated in cardiac rehabilitation.
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