Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorJody W.ZylkeMD, Contributing EditorIndividualAuthor
To the Editor: Dr Nishime and colleagues1 recently reported that heart rate recovery (HRR) of less than 12 beats per minute in the first minute following exercise predicted all-cause mortality in patients undergoing exercise stress testing. They also found that HRR and the Duke treadmill exercise score (DTES) independently predicted all-cause mortality in these patients. The authors state that all-cause mortality is an "objective and unbiased end point," unlike cardiac mortality. Nevertheless, since patients are usually referred for exercise testing to assess cardiac symptoms and risk of coronary events, the study would have been far more clinically useful if the cardiac-specific end points of cardiac death and nonfatal infarction had been reported.
Yoder S, Schwartz RG. Abnormal Heart Rate Recovery and Risk of Death. JAMA. 2001;285(7):879-880. doi:10.1001/jama.285.7.879