Initial in-hospital heart rate is associated with long-term survival in patients with acute ischemic stroke

Jiann-Der Lee,Chuan-Pin Lee,Tsong-Hai Lee,Yen-Chu Huang,Ya-Wen Kuo,Meng Lee

doi:10.1007/s00392-021-01953-5

Abstract

AimsIncreased heart rate has been associated with stroke risk and outcomes. The purpose of this study was to explore the long-term prognostic value of initial in-hospital heart rate in patients with acute ischemic stroke (AIS).MethodsWe analyzed data from 21,655 patients with AIS enrolled (January 2010–September 2018) in the Chang Gung Research Database. Mean initial in-hospital heart rates were averaged and categorized into 10-beat-per-minute (bpm) increments. The primary and secondary outcomes were all-cause mortality and cardiovascular death. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using multivariable adjusted Cox proportional hazard models, using the heart rate < 60 bpm subgroup as the reference.ResultsThe adjusted HRs for all-cause mortality were 1.23 (95% CI 1.08–1.41) for heart rate 60–69 bpm, 1.74 (95% CI 1.53–1.97) for heart rate 70–79 bpm, 2.16 (95% CI 1.89–2.46) for heart rate 80–89 bpm, and 2.83 (95% CI 2.46–3.25) for heart rate ≥ 90 bpm compared with the reference group. Likewise, heart rate ≥ 60 bpm was also associated with an increased risk of cardiovascular death (adjusted HR 1.18 [95% CI 0.95–1.46] for heart rate 60–69 bpm, 1.57 [95% CI 1.28–1.93] for heart rate 70–79 bpm, 1.98 [95% CI 1.60–2.45] for heart rate 80–89 bpm, and 2.36 [95% CI 1.89–2.95] for heart rate ≥ 90 bpm).ConclusionsHigh initial in-hospital heart rate is an independent predictor of all-cause mortality and cardiovascular death in patients with AIS.Graphical abstract

Highlights

Despite improvements in secondary prevention treatment, the incidence rates of mortality and recurrent cardiovascular events post-stroke remain high [1,2,3]
Experimental studies have suggested that lowering the heart rate may protect against cerebral ischemia by reducing oxidative stress and improving endothelial function [14], whether a lower initial in-hospital heart rate is associated with a better prognosis in patients with acute ischemic stroke (AIS) has yet to be elucidated
In this study of 21,655 patients with AIS, we found that the mean initial in-hospital heart rate was a predictor of allcause mortality and cardiovascular death, independently of other known risk factors such as age and stroke severity

Summary

Introduction

Despite improvements in secondary prevention treatment, the incidence rates of mortality and recurrent cardiovascular events post-stroke remain high [1,2,3]. This indicates that many risk factors have yet to be identified. Experimental studies have suggested that lowering the heart rate may protect against cerebral ischemia by reducing oxidative stress and improving endothelial function [14], whether a lower initial in-hospital heart rate is associated with a better prognosis in patients with acute ischemic stroke (AIS) has yet to be elucidated. The objective of this study was to evaluate the relationship between mean initial in-hospital heart rate and long-term mortality in a large population of AIS patients with an extended follow-up

Methods

Results

Conclusion