Avaliação da frequência cardíaca como marcador de gravidade clínica em pacientes em pronto atendimento

Abstract

Studies have been using Heart Rate Variability (HRV) as an indirect method of evaluating the functioning of the Autonomic Nervous System (ANS). This analysis is based on the mathematic analysis of the assessment time oscillation between the adjusted physical tests, to evaluate both the assessment time analysis and the calculated effort to estimate the assessment level of continuous effort. Recent studies that gather a large number of cases, so much so that they can be used as a reference, for linear and non-linear HRV indices, in any disease conditions that are encountered during care and in the different age groups being evaluated in a health service. Emergency services, remain scarce. It is challenging to determine which patient needs immediate and intensified care. An adequate and rapid risk assessment of patients is of great importance. In recent years, cardiac function parameters, that is, HRV, allow risk stratification to assess and enhance the clinical course of patients independent of the disease. Objective: To evaluate the autonomic functioning through the measurement of HRV in patients treated at the Emergency Department, in different age groups and in different disease conditions. Methods: The HRV was collected from 101 patients in service at the Emergency Department Dr José Osmar Segura Lopes, in the city of Guapiaçu-SP, from July 2020 to July 2022.The indices that are most frequently used in the literature as markers of autonomic function were evaluated: Heart Rate (HR), the square root of the mean square of the differences between adjacent normal RR intervals, over a time interval, expressed in milliseconds (RMSSD), and the high-frequency power measured in milliseconds squared (HFms2). The software used to calculate these variables was Kubios HRV Premium. The values of the selected variables were transformed into the homeostatic level classification coding as proposed by Godoy and Gregório (2022). The statistical analysis was be performed using the StatsDirect3 software .3.5 of March 22, 2021. An alpha error of 5% was admitted, with P values less than or equal to 0.05 being considered significant. Results: although age did not influence HRV in our study, the classification of homeostatic level used was able to identify diseases in different degrees of severity in patients admitted to the emergency service, with the most severe cases (grade 3) presenting the lowest HR, RMSSD and HF ms2 values. Conclusion: The present study, with the aid of HRV exams in patients referred at the Emergency Room, allowed us to conclude that the classification of these patients according to the Homeostatic Level at admission is strongly associated with the degree of clinical severity and can be used as a marker of prognosis. Further long-term study with larger series may confirm these findings.