Association between heart rate on admission and in-hospital mortality among general inpatients Insights from Japan Adverse Drug Events (JADE) study

Association between heart rate (HR) and in-hospital mortality in general patients irrespective of underlying diseases were not well scrutinized. We assessed the relationship between HR on admission and in-hospital mortality among general inpatients. We used data from Japan Adverse Drug Events (JADE) study, a prospective cohort study. One tertiary care hospital in Japan with 13 medical and 12 surgical wards, and an intensive care unit (ICU). Patients (n= 2360) were >= 12 years old and admitted to this hospital within 3months; and pregnant women were excluded. We assessed the relationship between HR and mortality in five (< 60, 60-79, 80-99, 100-119, >= 120 beats per minutes [bpm]) groups. We also compared the five HR groups according to the age (< 70 years; >= 70years) and wards (medical; surgical; ICU). We enrolled 2360 patients (median age, 71 [interquartile range (IQR) 58-81] years) including 1147, 1068, and 145 patients in the medical and surgical wards, and the ICU, respectively. The median (IQR) HR on admission was 78 (68-91) bpm. Ninety-five patients died during hospitalization. Mortalities in the < 60, 60-79, 80-99, 100-119, and >= 120bpm groups were 2.9% (5/175), 2.7% (28/1047), 3.4% (26/762), 8.2% (24/291), and 14.3% (12/84), respectively (P<. 001). The adjusted odds ratios of in-hospital mortality was 3.64 (95% CI 1.88-7.05, P<. 001) when HR was >= 100bpm in the medical ward; and 5.69 (95% CI 1.72-18.82, P=.004) when HR >= 120bpm in the surgical ward. There was no statistically significant relationship with the ICU. In conclusion, higher HR should be associated with in-hospital mortality among patients with general diseases. Even with less severe condition or outside ICU, HR should be directed attention to and patients with high HR on admission should be taken additional therapy to reduce the further risk of deterioration.