Bennett, A. N.

Boos, Christopher John

Bull, A. M. J.

Cullinan, P.

Fear, N. T.

Khattab, Ahmed

Maqsood, Rabeea

Schofield, S.

Bournemouth University Research Online

Ultra-short term heart rate variability and combat-related traumatic injury- is there an association? Findings from the ADVANCE study, UK Presenter: Rabeea Maqsood PhD student, Bournemouth University rmaqsood@bournemouth.ac.uk    8th September 2023 OP146 Rabeea Maqsood, Susie Schofield,  Alexander N Bennett,  Anthony M J Bull, Nicola T Fear, Paul Cullinan, Ahmed Khattab and Christopher J Boos, for the ADVANCE study    -Explore the association between CRTI and HRV among a contemporary population of military personnel and veterans.  -Examine the impact of injury severity and mechanism on HRV.  -Combat-related traumatic injury (CRTI) has been associated with increased systemic inflammation, arterial stiffness, metabolic syndrome1, hypertension2 and coronary artery disease 3,4.   Background Aims  -Limited evidence on the relationship between non-acute traumatic injuries5  and Heart Rate Variability (HRV) i.e. the variation in time interval between two consecutive heart beats6 1. Boos, C. J., Schofield, S., Cullinan, P., Dyball, D., Fear, N. T., Bull, A. M., Pernet, D. and Bennett, A.N., 2021. Association between combat-related traumatic injury and cardiovascular risk. Heart, 108 (5), 367-374.                                                                                                    2. Howard, J. T., Stewart, I. J., Kolaja, C. A., Sosnov, J. A., Rull, R. P., Torres, I., Janak, J. C., Walker, L. E., Trone, D. W. and Armenta, R. F., 2020. Hypertension in military veterans is associated with combat exposure and combat injury. Journal of hypertension, 38 (7), 1293-1301.       3. Stewart, I. J., Poltavskiy, E., Howard, J. T., Janak, J. C., Pettey, W., Zarzabal, L. A., Walker, L. E., Beyer, C. A., Sim, A., Suo, Y. and Redd, A., 2021. The enduring health consequences of combat trauma: a legacy of chronic disease. Journal of general internal medicine, 36 (3), 713-721.  4. Stewart, I. J., Sosnov, J. A., Howard, J. T., Orman, J. A., Fang, R., Morrow, B. D., Zonies, D. H., Bollinger, M., Tuman, C., Freedman, B. A. and Chung, K. K., 2015. Retrospective analysis of long-term outcomes after combat injury: a hidden cost of war. Circulation, 132 (22), 2126-2133 5. 5. Maqsood, R., Khattab, A., Bennett, A.N. and Boos, C.J., 2023. Association between non-acute Traumatic Injury (TI) and Heart Rate Variability (HRV) in adults: A systematic review and meta-analysis. PLoS One, 18 (1), p.e0280718..                                                             6.Malik, M., 1996. Heart rate variability: Standards of measurement, physiological interpretation, and clinical use: Task force of the European Society of Cardiology and the North American Society for Pacing and Electrophysiology. Annals of Noninvasive Electrocardiology, 1 (2),151-181.  Variables  Sample Size n=862 servicemen   -baseline data from the ADVANCE study8 Exposure variable CRTI (Yes/no) Injury Severity (NISS*>25 and NISS*<25) (2008) *New Injury Severity Score Injury Mechanism (Blast vs others) Outcome variable  Ultra-short term HRV (HRVUST)9  Root Mean Square of Successive Differences (RMSSD)- a time domain measure of HRV  Confounders  Age at assessment, rank, time from injury, ethnicity  Statistical analysis  Multivariate regression analysis 3 models (CRTI, Injury severity, Mechanism) Methodology  7. The ADVANCE study. Available at:  https://www.advancestudydmrc.org.uk/                                                                                                                                                                                                                                                                                                         8. Bennett, A.N., Dyball, D.M., Boos, C.J., Fear, N.T., Schofield, S., Bull, A.M. and Cullinan, P., 2020. Study protocol for a prospective, longitudinal cohort study investigating the medical and psychosocial outcomes of UK combat casualties from the Afghanistan war: the advance study. BMJ open, 10 (10), p.e037850.                                                                                                                                                                                                                                                                                                                                                                     9. Maqsood, R., Schofield, S., Bennett, A.N., Bull, A.M., Fear, N.T., Cullinan, P., Khattab, A. and Boos, C.J., 2023. Relationship between combat-related traumatic injury and ultrashort term heart rate variability in a UK military cohort: findings from the ADVANCE study. BMJ Mil Health.  ArmeD serVices trAuma rehabilitatioN outComE (ADVANCE) study7 No significant differences in:  Demographic, anthropometric and haemodynamic data except heart rate and RMSSD9  Results  9. Maqsood, R., Schofield, S., Bennett, A.N., Bull, A.M., Fear, N.T., Cullinan, P., Khattab, A. and Boos, C.J., 2023. Relationship between combat-related traumatic injury and ultrashort term heart rate variability in a UK military cohort: findings from the ADVANCE study. BMJ Mil Health.  -CRTI was associated with a 13% lower geometric mean ratio (GMR) RMSSD versus the uninjured group (GMR 0.87, 95%CI 0.89-0.94, p<0.001)9.  -Blast injuries (GMR: 0.86, 95%CI 0.79-0.93, p<0.001) were also independently associated with a 14% lower GMR RMSSD9.  -A higher injury severity (NISS>25) was significantly associated with a 22% lower GMR RMSSD (GMR 0.78, 95%CI 0.69-0.89, p<0.001)9.  Conclusion  -CRTI, higher injury severity and blast are independent predictors of  lower HRVUST. -In the injured group, indicative of autonomic imbalance, lower para-sympathetic tone and elevated sympathetic tone. 9. Maqsood, R., Schofield, S., Bennett, A.N., Bull, A.M., Fear, N.T., Cullinan, P., Khattab, A. and Boos, C.J., 2023. Relationship between combat-related traumatic injury and ultrashort term heart rate variability in a UK military cohort: findings from the ADVANCE study. BMJ Mil Health.  

P146 Ultra-short term heart rate variability and combat-related traumatic injury- is there an association? Findings from the ADVANCE study, UK.

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P146 Ultra-short term heart rate variability and combat-related traumatic injury- is there an association? Findings from the ADVANCE study, UK.

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