Polyscore of autonomic parameters for risk stratification of the elderly general population: The Polyscore study

Alexander Steger, Michael Dommasch, Alexander Müller, Daniel Sinnecker, Katharina M. Huster, Teresa Gotzler, Othmar Gotzler, Alexander Hapfelmeier, Kurt Ulm, Petra Barthel, Katerina Hnatkova, Karl Ludwig Laugwitz, Marek Malik, Georg Schmidt

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Aims: Present society is constantly ageing and elderly frequently suffer from conditions that are difficult and/or costly to treat if detected late. Effective screening of the elderly is therefore needed so that those requiring detailed clinical work-up are identified early. We present a prospective validation of a screening strategy based on a Polyscore of seven predominantly autonomic, non-invasive risk markers. Methods and results: Within a population-based survey in Germany (INVADE study), participants aged ≥60 years were enrolled between August 2013 and February 2015. Seven prospectively defined Polyscore components were obtained during 30-min continuous recordings of electrocardiogram, blood pressure, and respiration. Out of 1956 subjects, 168 were excluded due to atrial fibrillation, implanted pacemaker, or unsuitable recordings. All-cause mortality over a median 4-year follow-up was prospectively defined as the primary endpoint. The Polyscore divided the investigated population (n = 1788, median age: 72 years, females: 58%) into three predefined groups with low (n = 1405, 78.6%), intermediate (n = 326, 18.2%), and high risk (n = 57, 3.2%). During the follow-up, 82 (4.6%) participants died. Mortality in the Polyscore-defined risk groups was 3.4%, 7.4%, and 17.5%, respectively (P < 0.0001). The Polyscore-based mortality prediction was independent of Framingham score, diabetes, chronic kidney disease, and major stroke and/or myocardial infarction history. It was particularly effective in those aged <75 years (n = 1145). Conclusion: The Polyscore-based mortality risk assessment from short-term non-invasive recordings is effective in the elderly general population, especially those aged 60-74 years. Implementation of a comprehensive Polyscore screening of this age group is proposed to advance preventive medical care.

Original languageEnglish
Pages (from-to)789-796
Number of pages8
Issue number5
StatePublished - 1 May 2021


  • Autonomic markers
  • Elderly general population
  • Polyscore
  • Prospective validation
  • Risk assessment


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