Prognostic value of the post-exercise heart rate recovery and BHDE-index in chronic obstructive pulmonary disease.

Publication date: Jul 17, 2023

The BODE index, consisting of body mass index (B), airflow obstruction (O), dyspnea score (D), and exercise capacity (E), can predict outcomes in COPD. However, when spirometry was restricted to prevent cross-infection such as COVID-19 pandemic, a modified index would be needed. Because cardiovascular dysfunction is associated with poor clinical outcomes in COPD, we conducted a novel BHDE-index by replacing spirometry with post-exercise heart rate recovery (HRR, H) and evaluated its predictive performance in this observational study. From January 2019 to December 2019, enrolled patients were analyzed as a derivation cohort for the setup of the model. This model was verified in another group of patients generated between January 2020 and December 2020, as the validation cohort. The post exercise HRR was defined as the difference of heart rate immediately after and 1 min after test cessation. A total of 447 patients with COPD were enrolled. Patients with abnormal HRR were older, with more severe airway obstruction, severe airway symptoms, faster resting heart rate, shorter 6-min walk distance and higher frequency of severe acute exacerbation in previous one year. The prediction performance of the BHDE-index for one-year severe COPD exacerbation was similar to that of the BODE-index in both the derivation and validation groups [area under the receiver operating characteristic curve (AUROC) 0. 76 vs. 0. 75, p = 0. 369; AUROC 0. 74 vs. 0. 79, p = 0. 05]. The prediction performance for 1 year mortality was also similar between BHDE-index and BODE-index in both cohorts [AUROC 0. 80 vs. 0. 77, p = 0. 564; 0. 76 vs. 0. 70, p = 0. 234]. Univariate and multivariate analyses also showed that the BHDE-index was an independent and important predictor of annual severe COPD exacerbation in the derivation and validation cohorts. The BHDE-index is a good and easy-to-perform prediction model for the risk of severe acute exacerbation and 1-year mortality in COPD wherever spirometry results are unavailable.

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Concepts Keywords
Covid Heart rate recovery
Older Pulmonary function
Pandemic Pulmonary rehabilitation


Type Source Name
disease MESH chronic obstructive pulmonary disease
disease MESH infection
disease MESH COVID-19 pandemic
disease MESH airway obstruction
disease VO frequency
pathway REACTOME Reproduction
disease MESH cross infection
disease MESH death
drug DRUGBANK Medical air
drug DRUGBANK Etoperidone
disease MESH comorbidity
disease IDO history
disease MESH heart failure
disease VO volume
drug DRUGBANK Gold
drug DRUGBANK Saquinavir
disease VO report
disease MESH emergency
disease VO USA
disease VO age
disease VO time
drug DRUGBANK Aspartame

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