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Title: Heart rate as a marker of incidence and prognosis of cardiovascular diseases in different populations : evidence from linked electronic health records using the CALIBER platform and the 4C clinical cohort
Author: Archangelidi, O.
ISNI:       0000 0004 8503 1972
Awarding Body: UCL (University College London)
Current Institution: University College London (University of London)
Date of Award: 2016
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Background: Resting heart rate (RHR) is an easily accessible clinical parameter. In spite of the well-established association between resting heart rate and mortality in men and women, potential links between the marker and more specific cardiovascular diseases (CVDs) have not yet been explored. No previous research has used clinically collected RHR measurements from primary care settings. Normal RHR values have not been firmly established, although this is crucial in clinical practice and promotion of personalised health care. Objectives: The main objectives of this PhD are to: -Examine the association between RHR and the onset of specific fatal and non-fatal cardiovascular diseases -Examine the association between RHR and the prognosis of people with coronary artery disease (CAD) --Investigate the association between RHR and the onset and prognosis of atrial fibrillation -Describe the establishment of a consented clinical cohort resource of patients with CAD (4C) -Compare electronic health records (EHR) processes and data with the 4C consented clinical cohort Methods: I used CALIBER, a linked electronic health records (EHR) platform that links primary and secondary care data, myocardial infarction disease registry and mortality data. Additionally, to establish a clinical cohort of people with CAD, I consented, recruited and collected anthropometric and biomarker data including RHR from patients attending chest pain clinics and angiography labs in London. Results: RHR was associated with myocardial and arrhythmic disorders, but not with coronary disease or peripheral arterial disease. An average RHR of >70bpm in the general population was associated with increased hazards of specific CVDs and mortality particularly in men and should not be considered as normal. Additionally, increased RHR was strongly associated with higher risk of cardiovascular outcomes not currently considered as primary endpoints in trials, such as heart failure. Finally, higher HR is strongly associated with atrial fibrillation in men, but not in women. Conclusions: EHR provides a wealth of primary care data, so far unexplored that give insight into associations of heart rate with CVDs in healthy and CAD populations. Average RHR of >70bpm in the general male population is associated with increased myocardial and arrhythmic disorders risk, but not with coronary disease. Disaggregation of CVDs into its constituent phenotypes contributes to our understanding of disease mechanisms with implications for clinical practice and interpretation of clinical trials.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available