Heart rate variability and length of survival in hospice cancer patients

Do Hoon Kim, Jeong A Kim, Youn Seon Choi, Su Hyun Kim, June Young Lee, Young Eun Kim, Do Hoon Kim, Jeong A Kim, Youn Seon Choi, Su Hyun Kim, June Young Lee, Young Eun Kim

Abstract

We examined the association between heart rate variability (HRV) and survival duration to evaluate the usefulness of HRV as a prognostic factor for hospice cancer patients. In terminally ill cancer patients who visited the Hospice clinic, we checked demographic data, Karnofsky performance scale (KPS), HRV, dyspnea, anorexia, as well as fasting blood glucose and total cholesterol. After following up their duration of survival, we examined meaningful prognostic factors for predicting life expectancy through the survival analysis. A total of 68 patients were included in final analysis. As KPS was lower, or when combined with dyspnea or anorexia, the survival duration was much shorter. HRV parameters except heart rate were all impaired in most patients. In particular, the group with mean heart rate of 100 or more beats per minute and the group with standard deviations of normal-to-normal R-R intervals (SDNN) of 21.3 ms (75 percentile) or less showed significantly shorter survival duration. The final multivariate analysis adjusting for age, gender, fasting blood glucose, and total cholesterol showed that KPS, dyspnea, anorexia, and SDNN were significant prognostic factors in survival duration. For the first time, we report that SDNN is a prognostic factor in terminal cancer patients.

Keywords: Heart Rate Variability; Life Expectancy; Prognosis; Terminal Care.

Figures

Fig. 1
Fig. 1
Kaplan-Meier survival curves (n=68). (A) Karnofsky performance status scale* (P<0.001). (B) Anorexia (P=0.015). (C) Dyspnea (P=0.037). (D) Mean heart rate (dichotomized by 100 bpm). (E) SDNN (dichotomized by quartile 3, 21.3 msec). *KPS variable was grouped according to the reference level of palliative prognostic score.

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