Heart-Rate Profile during Exercise as a Predictor of Sudden Death

To the Editor: The study by Jouven and colleagues (May 12 issue) 1 advances our understanding of the factors involved in the precipitation of sudden death. However, the authors' assertion that exercise-induced changes in heart rate “may have clinical implications in terms of the early identification of high-risk subjects” is untenable given the very low incidence of sudden death in their studied population. Only 1.4 percent of the 5713 healthy middle-aged men died suddenly during the 23-year follow-up. On the basis of the criterion the investigators found most discriminating — subnormal exercise-induced increase in heart rate — 500 men would have . . .