The Importance of Heart Rate Recovery

Heart rate recovery (HRR) is the difference between a person’s heart rate at peak exercise and at one minute into recovery post-exercise.  It can predict overall mortality in people with cardiovascular disease.  Thus among people referred for a stress EKG all-cause mortality rates were 8% in patients with abnormal heart-rate recovery (i.e. less than 12 beats/minute) and 2% in patients with normal recovery.  Now a large study has shown that cardiac-rehabilitation programs can restore patients’ HRR to normal (i.e. more than12 beats/minute).  The study was done at the Cleveland Clinic, and is published in the journal Circulation. 

The study included 1,070 consecutive patients who had stress tests before and after a physician-supervised exercise program; the program lasted 12 weeks, and was based on established Phase 2 protocols from the American Association of Cardiovascular and Pulmonary Rehabilitation. The HRR and mortality were the endpoints of interest; patients were followed for an average of 8.1 years.

Of 544 patients with abnormal baseline HRR, 225 (41%) had a normal HRR after the rehab program.  There were 197 deaths recorded (18%).  In those with an abnormal HRR at the start, failure to normalize by the end of the rehab program predicted a 2.15-times higher mortality rate, whereas an abnormal initial HRR followed by a normal HRR at the end of rehab meant a similar survival rate to those with a normal initial HRR.

These results are self-explanatory. Top quote Dr Leslie Cho, the principal investigator: “There’s no medicine that can do that.  Especially in terms of mortality, if we had a medicine that could make this dramatic an impact, it would be the blockbuster of the century”.  So there’s no excuse not to accept the opportunity of a cardiac rehab program, when it’s offered.