scholarly journals Mortality and Cause of Death in Younger Homeless Veterans

2018 ◽  
Vol 133 (2) ◽  
pp. 177-181 ◽  
Author(s):  
John A. Schinka ◽  
Katherine C. Leventhal ◽  
William A. Lapcevic ◽  
Roger Casey
Keyword(s):  
Cause Of Death ◽  
Mortality Risk ◽  
Metabolic Diseases ◽  
Survival Rates ◽  
Hazard Ratio ◽  
Middle Aged ◽  
Adult Age ◽  
Risk Of Death ◽  
Homeless Veterans

Objectives: Increased mortality has been documented in older homeless veterans. This retrospective study examined mortality and cause of death in a cohort of young and middle-aged homeless veterans. Methods: We examined US Department of Veterans Affairs records on homelessness and health care for 2000-2003 and identified 23 898 homeless living veterans and 65 198 non-homeless living veterans aged 30-54. We used National Death Index records to determine survival status. We compared survival rates and causes of death for the 2 groups during a 10-year follow-up period. Results: A greater percentage of homeless veterans (3905/23 898, 16.3%) than non-homeless veterans (4143/65 198, 6.1%) died during the follow-up period, with a hazard ratio for risk of death of 2.9. The mean age at death (52.3 years) for homeless veterans was approximately 1 year younger than that of non-homeless veterans (53.2 years). Most deaths among homeless veterans (3431/3905, 87.9%) and non-homeless veterans (3725/4143, 89.9%) were attributed to 7 cause-of-death categories in the International Classification of Diseases, 10th Revision (cardiovascular system; neoplasm; external cause; digestive system; respiratory system; infectious disease; and endocrine, nutritional, and metabolic diseases). Death by violence was rare but was associated with a significantly higher risk among homeless veterans than among non-homeless veterans (suicide hazard ratio = 2.7; homicide hazard ratio = 7.6). Conclusions: Younger and middle-aged homeless veterans had higher mortality rates than those of their non-homeless veteran peers. Our results indicate that homelessness substantially increases mortality risk in veterans throughout the adult age range. Health assessment would be valuable for assessing the mortality risk among homeless veterans regardless of age.

scholarly journals Assessment of Mortality and Its Associated Risk Factors in Patients with Transfusion Dependent Thalassemia in India

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 973-973
Author(s):  
Rakesh Dhanya ◽  
Rajat Kumar Agarwal ◽  
Amit Sedai ◽  
Ankita Kumari ◽  
Lalith Parmar ◽  
...  
Keyword(s):  
Risk Factors ◽  
Overall Survival ◽  
Mortality Risk ◽  
Hazard Ratio ◽  
Cardiac Complications ◽  
Public Healthcare ◽  
Study Cohort ◽  
Management Options ◽  
Risk Of Death

Introduction: An assessment of morbidity and mortality caused by transfusion dependent thalassemia in India has never really been done despite thalassemia being the most prevalent life threatening non-communicable disorder of childhood. There is little structured understanding identifying the key risk factors feeding into research and policy making for effective management of thalassemia. With an estimated 10,000-12,000 children born with thalassemia each year in India, in addition to increasing focus on early pregnancy targeted screening, it seems critical to increase our understanding of risk factors associated with early mortality and morbidity. This is also relevant to family counselling about management options. Methodology: A retrospective analysis of mortality key risk factors in patients suffering from thalassemia major from 5 thalassemia day care centres in India was carried out. This included a total of 1,087 patients (656 males and 431 females with a median age of 8.6 years) enrolled for care between 1 Jan 2010 - 31 Oct 2018 at these centres. These centres were set up by a non-profit organization in collaboration with blood banks and /hospital facilities with the objective to provide comprehensive thalassemia care; A common web-based application was employed (ThalCare™). This system was used to track information associated with treatment including disease history at enrolment, demographic data and follow-up information. All analyses were performed with R Statistical software (3.5.2). Survival analysis was done from the age at presentation to the centre till October 2018. The reasons for mortality were categorized. Overall survival was also separately analyzed for patients in their 1st,2nd, 3rd or subsequent decades of life. The Cnaan and Ryan approach was used as patients entered and left the study cohort (left censored and right truncated data) and observation began only at enrolment and not at disease onset Results: The median age at enrolment was 5.4 years and the median follow up at the centre was 2.5 years. A total of 86 patients were cured by bone marrow transplantation (BMT), 13 of them moved to other centres for care and 41 patients died during the study period (28 males and 13 females). The median age at death was 15.4 years. Actuarial survival at 26.9 years of age was 50% (Figure 1) and under-five mortality was 7 times higher than the general population. Patients with transfusion-transmitted infections (TTI) had 3.4 times higher risk of death (p=0.031). Serum ferritin >4,000 ng/dL was associated with 4.6 times higher risk of mortality compared to ferritin <1,000 ng/dL (p=0.00063). Hemoglobin drop >2 gm/dL/week had 7.7 times higher mortality risk compared to <1 gm/dL/week (p<0.0001). Social determinants (sex, economic status and distance from centre), splenectomy, age at first transfusion and even cardiac complications were not associated with higher mortality risk. Results are summarized in Table 1. A multivariable analysis of risk factors which emerged as univariately significant showed that Hb drop of > 2 gm/week (hazard ratio 5.58 ,p=0.0007) and lack of attention towards care for possible prevention from TTI (hazard ratio 2.86, p=0.0004) are factors independently associated with high mortality. Table 2 shows that in patients born after the year 2,000 overall survival is 85.2% compared to 29.4% for patients born earlier. Main causes of death were infection, iron overload, TTIs, and alloimmunization; In a quarter of patients the cause of death was unknown (Figure 2). Patients who received more than 4 years of adequate care had more than 66% mortality risk reduction (p<0.0001). Conclusion: Comprehensive care right from an early age at dedicated management centres is key to improving life expectancy of thalassemia patients in India. Optimizing blood transfusion, intensifying chelation and preventing TTIs seem particularly important. Sustained efforts in these areas coupled with increased prevention and access to safe BMT will ease the burden for both families and public healthcare. Disclosures No relevant conflicts of interest to declare.

Abstract P098: Slower Gait Speed is Associated with Increased Mortality Risk in Chronic Kidney Disease.

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Baback Roshanravan ◽  
Cassiane Robinson-Cohen ◽  
Kushang V Patel ◽  
Greg Levin ◽  
Ian H de Boer ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Gait Speed ◽  
Proportional Hazards ◽  
Prognostic Significance ◽  
Continuous Variable ◽  
Hazard Ratio ◽  
Risk Of Death ◽  
Social Security Death Index

Objective: Skeletal muscle dysfunction (sarcopenia) is an under-recognized complication of chronic kidney disease (CKD) that may have important clinical consequences. Gait speed is associated with sarcopenia and comorbid disease burden among older adults; however, little is known about the prognostic significance of gait speed in CKD. We determined the association of gait speed with all-cause mortality in a prospective cohort of non-dialysis CKD patients. Methods: We measured usual gait speed over 4-meters in 309 participants from a prospective study of non-dialysis CKD. Included subjects had an estimated glomerular filtration rate (eGFR ckdepi ) <90mL/min/1.73m 2 , were stroke-free and did not require a wheelchair for ambulation. Study coordinators assessed mortality during follow-up by phone contacts, medical record review, and the social security death index. We evaluated gait speed continuously, and using a cut point of 0.8 m/s, consistent with previous studies. We used Cox's proportional hazards to estimate the association of gait speed with mortality after adjustment for age, sex, race, smoking, diabetes, pre-existing CAD, BMI, eGFR and hemoglobin. Results: Median follow-up time was 2.7 years; range 27 days to 4.8 years. The mean age was 58.9 ± 13 years and mean eGFR by cystatin C (eGFR cysc ) was 48.5 ± 23mL/min/1.73m 2 . There were a total of 31 deaths (10.4%) during follow-up. Unadjusted mortality rates were 23 and 80 deaths per 1,000 person-years among participants who had a gait speed of >0.8m/s versus ≤0.8m/s, respectively. After full adjustment, gait speed ≤0.8m/s was associated with a 2.8-fold greater risk of death compared to a gait speed >0.8 m/s. Gait speed was also strongly associated with mortality when analyzed as a continuous variable ( Table ) and a stronger predictor of death than age, history of CAD, or diabetes. No. Deaths (%) Model 1 + Model 2 # Hazard Ratio 95% CI Hazard Ratio 95% CI Gait speed * 32(10) 0.74 (0.64-0.86) 0.75 (0.64-0.87) >0.8m/s 13 (6) Reference Reference ≤0.8m/s 19(19) 3.49 (1.54-7.95) 2.84 (1.25-6.48) * Gait speed analyzed continuously per 10cm/s increase in speed. +Model 1: Adjusted for age, sex, race, study site #Model 2: adds smoking, BMI, eGFR cysc , diabetes, prevalent coronary disease. Conclusion: Gait speed is strongly associated with death in a cohort of middle-aged CKD patients.

scholarly journals Adiposity change and mortality in middle-aged to older Chinese: an 8-year follow-up of the Guangzhou Biobank Cohort Study

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e039239
Author(s):  
Ying Yue Huang ◽  
Chao Qiang Jiang ◽  
Lin Xu ◽  
Wei Sen Zhang ◽  
Feng Zhu ◽  
...  
Keyword(s):  
Cohort Study ◽  
Outcome Measures ◽  
Mortality Risk ◽  
Cancer Mortality ◽  
Secondary Outcome ◽  
Middle Aged ◽  
All Cause Mortality ◽  
Older Chinese ◽  
Cvd Mortality

ObjectiveTo examine the associations of change in body mass index (BMI) and waist circumference (WC) over an average of 4 years with subsequent mortality risk in middle-aged to older Chinese.DesignProspective cohort study based on the Guangzhou Biobank Cohort Study.SettingCommunity-based sample.Participants17 773 participants (12 956 women and 4817 men) aged 50+ years.Primary and secondary outcome measuresPrimary outcome measure was all-cause mortality. Secondary outcome measures were cardiovascular disease (CVD) and cancer mortality. Causes of death were obtained via record linkage, and coded according to the International Classification of Diseases (tenth revision).Results1424 deaths (53.4% women) occurred in the 17 773 participants (mean age 61.2, SD 6.8 years) during an average follow-up of 7.8 (SD=1.5) years, and 97.7% of participants did not have an intention of weight loss . Compared with participants with stable BMI, participants with BMI loss (>5%), but not gain, had a higher risk of all-cause mortality (HR=1.49, 95% CI 1.31 to 1.71), which was greatest in those who were underweight (HR=2.45, 95% CI 1.31 to 4.59). Similar patterns were found for WC. In contrast, for participants with a BMI of ≥27.5 kg/m2, BMI gain, versus stable BMI, was associated with 89% higher risk of all-cause mortality (HR=1.89, 95% CI 1.25 to 2.88), 72% higher risk of CVD mortality (HR=1.72, 95% CI 0.80 to 3.72) and 2.27-fold risk of cancer mortality (HR=2.27, 95% CI 1.26 to 4.10).ConclusionIn older people, unintentional BMI/WC loss, especially in those who were underweight was associated with higher mortality risk. However, BMI gain in those with obesity showed excess risks of all-cause and cancer mortality, but not CVD mortality. Frequent monitoring of changes in body size can be used as an early warning for timely clinical investigations and interventions and is important to inform appropriate health management in older Chinese.

scholarly journals IMPACT OF HIGH BODY MASS INDEX ON FRAILTY AND MORTALITY IN MIDDLE-AGED AND OLDER ADULTS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S683-S683
Author(s):  
Kulapong Jayanama ◽  
Olga Theou ◽  
Judith Godin ◽  
Leah Cahill ◽  
Kenneth Rockwood
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Mortality Risk ◽  
Metabolic Diseases ◽  
Smoking Status ◽  
Frailty Index ◽  
High Body Mass Index ◽  
Mortality Data ◽  
Middle Aged ◽  
Health And Nutrition

Abstract Obesity is associated with higher risk of metabolic diseases. How body mass index (BMI) relates to mortality across frailty levels is controversial. We investigated the association of high BMI with frailty, and their effects on mortality. We included 36,583 participants aged ≥50 years from the 1999-2006 National Health and Nutrition Examination Survey (NHANES) cohorts (7,372) and 29,211 participants aged ≥50 years from wave 1 (2004) of Survey of Health Ageing and Retirement in Europe (SHARE). BMI was categorized as: normal: 18.5-24.9 kg/m2, overweight: 25-29.9, obese I: 30-34.9 and obese II+III: &gt;35. A frailty index (FI) was constructed excluding nutrition-related items using 36 items for NHANES and 68 items for SHARE. Mortality data were obtained until 2015. All analyses were adjusted for educational, marital, working and smoking status. In participant aged 50-65 years, higher BMI was associated with greater frailty. Being obese level II+III increased mortality risk in male participants aged 50-65 years with FI≤0.1 [NHANES (hazard ratio (HR) 2.10, 95%CI 1.17-3.79); SHARE (2.35,1.14-4.87)]. In males aged &gt;65 years with FI&gt;0.3, being overweight and obese (any level) decreased mortality risk. In females aged 50-65 years, higher BMI was not associated with mortality across all frailty levels. BMI and frailty were cross-sectionally associated. The subsequent mortality impact differed by age, sex, and frailty. Obesity was not associated with mortality in middle-aged females, regardless of the degree of frailty. In males, obesity was harmful in those who were fit in middle age and protective in moderately/severely frail older ones.

Mortality after proximal hip fracture in the Singapore population

2005 ◽  
Vol 15 (3) ◽  
pp. 166-170 ◽  
Author(s):  
K.H. Lin ◽  
Y.W. Lim ◽  
Y.J. Wu ◽  
K.S. Lam
Keyword(s):  
Hip Fracture ◽  
Mortality Risk ◽  
Cox Regression ◽  
Regional Hospital ◽  
Age Group ◽  
Risk Of Death ◽  
The Past ◽  
The Mean ◽  
One Year

The aims were to prospectively assess the mortality risk following proximal hip fractures, identify factors predictive of increased mortality and to investigate the time trends in mortality with comparison to previous studies. Prospectively collected data from 68 consecutive patients who had been admitted to a regional hospital from May 2001 to September 2001 were reviewed. The mean age of the patients was 79.3 years old (range, 55–98) and 72.1% females. Patients were followed prospectively to determine the mortality risk associated with hip fracture over a two-year follow-up period. The acute in-hospital mortality rate at six months, one year and two years was 5.9% (4/68), 14.7% (10/68), 20.6% (14/68) and 25% (17/68) respectively. One-year and two-year mortality for those patients who were 80 or older was significantly higher than for other patients and the number of co-morbid illnesses also had significant effect. Cox regression was performed to determine the significant predictors for survival time. It was noted that patients 80 years or older were at higher risk of death compared with those less than 80 years as well as those with higher number of co-morbid illnesses. Our mortality rates have not declined in the past 10 years when compared with previous local studies. We conclude that for this group of patients studied, their mortality at one year and two years could be predicted by their age group and their number of co-morbid illnesses.

scholarly journals Effect of Empagliflozin on the Clinical Stability of Patients with Heart Failure and a Reduced Ejection Fraction: The EMPEROR-Reduced Trial

Circulation ◽  
2020 ◽  
Author(s):  
Milton Packer ◽  
Stefan D. Anker ◽  
Javed Butler ◽  
Gerasimos S. Filippatos ◽  
João Pedro Ferreira ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Functional Class ◽  
Hazard Ratio ◽  
Double Blind ◽  
Reduced Ejection Fraction ◽  
Risk Of Death ◽  
Nyha Functional Class ◽  
Patients With Heart Failure

Background: Empagliflozin reduces the risk of cardiovascular death or hospitalization for heart failure in patients with heart failure and a reduced ejection fraction, with or without diabetes, but additional data are needed about the effect of the drug on inpatient and outpatient events that reflect worsening heart failure. Methods: We randomly assigned 3730 patients with class II-IV heart failure with an ejection fraction of ≤40% to double-blind treatment with placebo or empagliflozin (10 mg once daily), in addition to recommended treatments for heart failure, for a median of 16 months. We prospectively collected information on inpatient and outpatient events reflecting worsening heart failure and prespecified their analysis in individual and composite endpoints. Results: Empagliflozin reduced the combined risk of death, hospitalization for heart failure or an emergent/urgent heart failure visit requiring intravenous treatment (415 vs 519 patients; empagliflozin vs placebo, respectively; hazard ratio 0.76, 95% CI: 0.67-0.87), P <0.0001. This benefit reached statistical significance at 12 days after randomization. Empagliflozin reduced the total number of heart failure hospitalizations that required intensive care (hazard ratio 0.67, 95% CI 0.50-0.90, P=0.008) and that required a vasopressor or positive inotropic drug or mechanical or surgical intervention (hazard ratio 0.64, 95% CI: 0.47-0.87, P=0.005). As compared with placebo, fewer patients in the empagliflozin group reported intensification of diuretics (297 vs 414), hazard ratio 0.67, 95% CI: 0.56-0.78, P<0.0001. Additionally, patients assigned to empagliflozin were 20-40% more likely to experience an improvement in NYHA functional class and were 20-40% less likely to experience worsening of NYHA functional class, with statistically significant effects that were apparent 28 days after randomization and maintained during long-term follow-up. The risk of any inpatient or outpatient worsening heart failure event in the placebo group was high (48.1 per 100 patient-years of follow-up), and it was reduced by empagliflozin (hazard ratio 0.70, 95% CI: 0.63-0.78), P<0.0001. Conclusions: In patients with heart failure and a reduced ejection fraction, empagliflozin reduced the risk and total number of inpatient and outpatient worsening heart failure events, with benefits seen early after initiation of treatment and sustained for the duration of double-blind therapy. Clinical Trial Registration: URL: https://clinicaltrials.gov Unique Identifier: NCT03057977

scholarly journals P298 The long-term impact of persistent pulmonary hypertension in patients undergoing TAVR with a self-expanding valve

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
M Drakopoulou ◽  
S Soulaidopoulos ◽  
G Oikonomou ◽  
P Toskas ◽  
M Xanthopoulou ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Aortic Valve ◽  
Mitral Regurgitation ◽  
Ejection Fraction ◽  
Confidence Intervals ◽  
Hazard Ratio ◽  
Cumulative Mortality ◽  
Risk Of Death ◽  
The Impact

Abstract Background Persistent severe pulmonary hypertension (PH) is considered to negatively affect early and late outcomes of patients undergoing aortic valve surgery. There is limited data however, cincerning the incidence of persistent PH after transcatheter aortic valve replacement (TAVR) and its impact on outcome is limited. Purpose We sought to investigate the impact of persistent PH on clinical outcomes of patients undergoing TAVR with a self-expanding valve. Methods Consecutive patients with severe symptomatic aortic stenosis scheduled for TAVR in our tertiary center were included in the study. Prospectively collected data before and after TAVR were retrospectively analyzed in all patients. Severe PH was defined as systolic pulmonary arterial pressure (sPAP) ≥45mmHg as assessed by echocardiography. For analysis purposes, patients with a sPAP decrease after TAVR to below 45mmHg were compared to patients with persistent PH following TAVR. All outcomes were evaluated according to the VARC-2 criteria. Results In total, 258 patients were included in this study (mean age 80.06 ± 7.50 years old, logEuroscore 24.50 ± 9.70%, NYHA III/IV Class 98.6%). Of these, 149 (57.8%) had sPAP less than 45mmHg and 109 (42.2%) had sPAP above or equal to 45mmHg at baseline. Patients with severe PH were older (81.1 ± 7.0 vs 79.1 ± 7.7, p = 0.034), presented with higher logEuroscore (26.9 ± 9.3% vs 22.5 ± 9.9%, p&lt; 0.001), lower ejection fraction (47.9 ± 9.3% vs 52.2 ± 8.5%, p&lt; 0.001) and higher rates of at least moderate mitral regurgitation (36.7% vs 16.2%, p = 0.002) compared to the group without PH. After TAVR, 161 (62.4%) patients had sPAP less than 45mmHg and 97 (37.6%) had sPAP above 45mmHg. There was a significant decrease of 2.4 ± 12.2mmHg in sPAP post TAVR (p &lt; 0.01). Multivariable analysis (univariate analysis: age, logEuroscore, pre TAVR mitral regurgitation, pre TAVR ejection fraction below 40%) identified pre TAVR ejection fraction below 40% to be the most powerful predictor for persistent PH after TAVR (odds ratio 2.4, 95% confidence interval 1.0.9 – 5.26, p = 0.028). During a mean follow up period of 26.6 ± 26.8, the presence of pre TAVR severe PH was not found to be predictive of cumulative mortality[Hazard Ratio(HR) : 1.57, 95% Confidence Intervals (CI) 0.92 – 2.66, p = 0.09). However, in the same follow up period, patients with persistent PH after TAVR had higher cumulative risk of death compared to patients with sPAP &lt; 45mmHg after TAVR (Hazard Ratio 0.49, 95% Confidence Intervals 0.29-0.82, p = 0.007) (Figure). Conclusions Our data suggest that TAVR is associated with a significant reduction in sPAP. Persistent PH post TAVR seems to be a predictor of higher cumulative mortality post TAVR. Abstract P298 Figure.

scholarly journals Anxiety and the risk of death in older men and women

2004 ◽  
Vol 185 (5) ◽  
pp. 399-404 ◽  
Author(s):  
Hein P. J. van Hout ◽  
Aartjan T. F. Beekman ◽  
Edwin De Beurs ◽  
Hannie Comijs ◽  
Harm Van Marwijk ◽  
...  
Keyword(s):  
Gender Difference ◽  
Anxiety Disorders ◽  
Mortality Risk ◽  
Older Men ◽  
Community Based ◽  
Men And Women ◽  
Risk Of Death ◽  
Screening Design ◽  
Older Men And Women

BackgroundThere are inconsistent reports as to whether people with anxiety disorders have a higher mortality risk.AimsTo determine whether anxiety disorders predict mortality in older men and women in the community Method Longitudinal data were used from a large, community-based random sample (n=3107) of older men and women (55–85 years) in The Netherlands, with a follow-up period of 7.5 years. Anxiety disorders were assessed according to DSM–III criteria in a two-stage screening design.ResultsIn men, the adjusted mortality risk was 1.78 (95% Cl 1.01–3.13) in cases with diagnosed anxiety disorders at baseline. In women, no significant association was found with mortality.ConclusionsThe study revealed a gender difference in the association between anxiety and mortality. For men, but not for women, an increased mortality risk was found for anxiety disorders.

scholarly journals Pessimism and risk of death from coronary heart disease among middle-aged and older Finns: an eleven-year follow-up study

2016 ◽  
Vol 16 (1) ◽  
Author(s):  
Mikko Pänkäläinen ◽  
Tuomas Kerola ◽  
Olli Kampman ◽  
Markku Kauppi ◽  
Jukka Hintikka
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Middle Aged ◽  
Risk Of Death ◽  
Follow Up Study

Resting heart rate, temporal changes in resting heart rate, and overall and cause-specific mortality

Heart ◽  
2017 ◽  
Vol 104 (13) ◽  
pp. 1076-1085 ◽  
Author(s):  
Mathias Seviiri ◽  
Brigid M Lynch ◽  
Allison M Hodge ◽  
Yi Yang ◽  
Danny Liew ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Heart Rate ◽  
Mortality Risk ◽  
Resting Heart Rate ◽  
Cox Models ◽  
Risk Of Death ◽  
Specific Mortality ◽  
Melbourne Collaborative Cohort Study ◽  
Trained Staff

ObjectiveMost studies investigating the association between resting heart rate (RHR) and mortality have focused on cardiovascular disease (CVD) mortality, and measured RHR at only one time point. We aimed to assess associations of RHR and changes in RHR over approximately a decade with overall and cause-specific mortality.MethodsWe used data from participants in the Melbourne Collaborative Cohort Study with RHR measures at baseline (1990–1994; n=41 386; 9846 deaths) and at follow-up (2003–2007; n=21 692; 2818 deaths). RHR measures were taken by trained staff, using Dinamap monitors. Cox models were used to estimate HR and 95% CI for the associations between RHR and mortality. Vital status and cause of death were ascertained until August 2015 and December 2013, respectively.ResultsAfter adjustment for confounders, including blood pressure and known medical conditions but not arrhythmias or atrial fibrillation, RHR was associated with a higher risk of death of similar magnitude for CVD (HR per 10 beats per minute (bpm)=1.11, 95% CI 1.07 to 1.16), cancer (HR=1.10, 95% CI 1.06 to 1.13) and other causes (HR=1.20, 95% CI 1.16 to 1.25). Higher mortality was observed for most cancer sites, including breast (HR=1.16, 95% CI 1.03 to 1.31), colorectal (HR=1.18, 95% CI 1.08 to 1.29), kidney (HR=1.27, 95% CI 1.03 to 1.57) and lung cancer (HR=1.19, 95% CI 1.10 to 1.29). Temporal increases in RHR were associated with higher mortality, particularly for individuals whose RHR increased by more than 15 bpm.ConclusionsRHR and changes in RHR over a decade are associated with mortality risk, including from causes other than CVD such as breast, colorectal or lung cancer. Monitoring of RHR may have utility in identifying individuals at higher mortality risk.

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