Dr Aparna Balasubramanian Discusses Necessary Care of High-Risk Patients With COPD

In this interview conducted for our CHEST Annual Meeting 2023 coverage, Aparna Balasubramanian, MD, assistant professor of medicine, Johns Hopkins School of Medicine, Division of Pulmonary and Critical Care, talks about the use of heart rate variability (HRV) as a biomarker in high-risk patients with chronic obstructive pulmonary disease (COPD), emphasizing that HRV shouldn’t be relied on as the only biomarker used.

Balasubramanian is an author on the study, "Decreased Cardiac Autonomic Function Is Associated With Higher Exacerbation Risk and Symptom Burden in Chronic Obstructive Pulmonary Disease," presented at the conference, which found that "heart rate variability (HRV) is associated with COPD symptom burden and exacerbation risk."

Transcript

How can HRV be monitored and used as a tool to help patients with COPD have better outcomes?

Heart rate variability is luckily a pretty easy thing to measure. It basically is getting a hold of what is the difference in the time between 2 heartbeats? If a person is stressed or if they are stimulated in some way, their heart rate will increase and the time between beats decreases, and then as they relax, the time between beats lengthens again. That variability is what's measured by heart rate variability—which means that all we really need is a solid heart rate monitor that will allow us to measure heart rate variability.

Luckily, a lot of wearable devices now measure heart rate and are getting into the space of measuring heart rate variability, as we understand more about heart rate variability being important for clinical outcomes like mortality, both from cardiovascular disease as well as, in this instance, COPD-related exacerbations.

COPD, as we know, is very closely linked to cardiovascular disease, and like I said, we've shown that heart rate variability is associated with exacerbations and symptoms. This opens up an interesting arena of research, generally, to help patients with COPD understand how their heart and their lungs work together a little bit better. More importantly, it potentially gives us an opportunity to say, “If we see differences in their heart rate variability, maybe we could predict or prevent exacerbations moving forward.”

What are the potential limitations or challenges associated with using biomarkers, like HRV, to identify high-risk patients with COPD?

I think it's really important to recognize that there's probably not a single biomarker that's going to tell us everything that we need to know about all high-risk COPD patients. A lot of this really needs to be couched in the context of an individual and a lot of other factors.

COPD and cardiovascular disease are pretty closely linked, so you could imagine heart rate variability could be altered by medications that people are on, by other comorbid diseases that they have. It could be different, in general, in a COPD population, so I think some of the challenges here are, we don't really know what normal heart rate variability is across the COPD population or whether there's clinically relevant thresholds that we need to define. We also don't necessarily know how sensitive this biomarker could be or how responsive it is to treatment for COPD as opposed to treatments for cardiovascular disease.

So, there's lots and lots of work that we would need to do to address a lot of these challenges, but it's an exciting and interesting observation that I think is worth that extra work.