Predictive value of continuous ambulatory electrocardiographic monitoring in elderly people

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Abstract
Objective: To determine the predictive value of findings on continuous ambulatory electrocardiographic monitoring in elderly subjects. Design - Retrospective chohort study. Ten year follow up of randomly selected elderly subjects who participated in ambulatory electrocardiography study in 1982. Mortality data derived from offical registers. Setting: Turku, Finland. Subjects: 480 people aged 65 or older in 1982 who were living in the coummunity, of whom 72% agreed to participate. Main outcome measures: Mortality from cardiac and non-cardiac causes during 10 year follow up. Results: In the univariate analysis adjusted for age, risk of death from cardiac causes was increased among those with ventricular ectopy of more than 100 beats during the day (odds ratio 2.6; 99% confidence interval 1.4 to 6.1) or at night (3.3; 1.1 to 9.8) and in those with multifocal ventricular ectopic beats during the day (2.3; 1.0 to 5.0) or night (3.0; 1.3 to 7.1) compared with those with no ventricular ectopy. Sinoatrial paused exceeding 1.5 seconds during the day (4.5; 1.8 to 11.1) were also associated with excess mortality from cardiac causes. None of the findings on ambulatory electrocardiography predicted death from non- cardiac causes. A further study of explantory variables in the stepwise logistic regression analysis showed that sinoatrial pauses exceeding 1.5 seconds (4.0; 95% confidence interval 1.8 to 8.9) and night time multifoucal ventricualr ectopy (2.7; 1.2 to 5.9) predicted excess mortality from cardiac causes independently of age or clinically evident heart disease. Conclusion: Daytime sinoatrial pauses exceeding 1.5 secods and night time multifocal ventricular ectopy in the ambulatory electrocardiogram predict increased mortality form cardic causes independenlty of clinically evident cardiac diseases in unselected elderly subjects.