| Background:The control of heart rate(HR)in patients with atrial fibrillation(AF)has important clinical significance,but the long-term monitoring of HR is difficult.At present,the oscillometric method blood pressure device(OMBP)is widely used in the mostly family.Because of the pulse deficit,the pulse rate(PR)of AF was slower than HR.However,some doctors and patients misunderstand to think that the PR was HR,which interfered the treatment of control HR.Objective:The present study is try to improve the value of OMBP to estimate the HR by reference to the mean pulse(mPR)and difference of PR(?PR)from three times OMBP measurements in patients with AF.Methods:The clinical data of patients with persistent or permanent AF from March to June of 2015 in our hospital were collected,including basic clinical information.After 10 min rest in sitting position,three PR and BP readings were taken by an OMBP(OMRON BP HEM-7200)with a minute interval.When the device was on,electrocardiogram was continuously recorded for 1 min for the HR.The first PR and HR were recorded as PR1 and HR1,and the averages of three PR and HR values were recorded as mPR and mHR.Meanwhile,the differences between the highest and lowest values among three PR and HR were calculated as the ?PR and ?HR,respectively.Furthermore,the patients were stratified on the ?PR into the 0-15 subgroup or the >15 subgroup.Simultaneously,we further in terms of mPR divided into the ?80,81-100 and >100 subgroups in the PR 0-15 group and PR >15 group,respectively.When the absolute difference of between mHR and mPR(mHR– mPR)was ?10 bpm,this study suggests that mPR was roughly equal to mHR,which as coincidence.The coincidence rate was the ratio between the number of coincidence patients and the total.All analyses were performed using the Excel 2007,SPSS19.0,and medcalc statistical software.Continuous variables were expressed as mean ± SD.Two independent sample t-test and the analysis of variance(ANOVA)were used for the statistical analysis.Linear regression analysis was performed to examine the correlation of mean HR with mean PR.The agreement between the PR and HR was evaluated by Bland–Altman plot method.Categorical variables presented as percentage were compared by the Pearson chisquare test.A p-value of less than 0.05 was considered statistically significant.Result:1.This study included 251 patients(males 55%,mean age was 66.0±11.5 year old)with permanent AF from March to June of 2015.Of them,215 were inpatients and 36 were outpatients.2.The HR1 was slightly higher than the PR1(83.4±17.5 vs 81.8±16.6 bpm,P<0.05)with a small difference of 1.5 bpm.Similarly,the mean HR was also slightly higher than the mean PR(84.8±17.8 vs 81.4±13.8 bpm,P< 0.05)but with a difference of 3.4 bpm.Furthermore,the ?PR was significantly higher than ?HR(12.1± 8.6 vs 3.6±2.5 bpm,P < 0.001).The positive correlation between mPR and mHR(R2= 0.696,P<0.05)was higher than that between PR1 and HR1(R2= 0.601,P<0.05).The Bland-Altman plot showed the range of 95% limits between mPR and mHR were from-16.0 to 22.8 bpm,narrower than those from-20.9 to 23.9 bpm between PR1 and HR1.3.On ?PR,187 patients were in the 0-15 subgroup and 64 patients in the >15 subgroup.The mean differences between mPR and mHR was 1.4 bpm in the 0-15 subgroup,however,this value was 9.1 bpm in the >15 subgroup.Meanwhile,the correlation between mPR and mHR in the 0-15 subgroup(R2= 0.800,P<0.05)was better than in the >15 subgroup(R2= 0.530,P<0.05).The range of 95% limits in the 0-15 subgroup(-11.3 to 14.2 bpm)were narrower than in the >15 subgroup(-19.9 to 38.1 bpm).These results indicated that in AF patients with ?PR of 0-15 bpm,the mPR could generally be used to estimate HR.4.Referring to mPR,we further divided the ?PR 0-15 group and ?PR >15 group into the ? 80,81-100 and >100 three subgroups,respectively.In the?PR 0-15 group,the coincidence rate was 93.9% when PR ? 80 bpm,96.3% when PR 81-100 bpm,and 88.9% when PR over 100 bpm,while in the?PR>15 group these values were 77.3%,67.7% and 45.5%.The results showed that the coincidence rate of mPR and mPR was as high as 95% when mPR?100bpm in?PR 0-15 subgroup.Conclusion:Our result indicated that it could not be simply taken the average of three PRs reported by OMBP as the HR in AF patients.However,when PR was 0-15 bpm and mPR?100bpm,the mPR could provide a clinically accepted estimation of HR.This conclusion provides a theoretical basis to obtain relatively reliable HR by correctly use OMBP for AF patients. |
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