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Impact of heart rate dynamics on mortality in the early phase after ischemic stroke: a prospective observational
Bernd Kallmünzer1, Tobias Bobinger1, Markus Kopp1
1Department of Neurology, Universitätsklinikum Erlangen, Germany.
Insights
A secondary rise in heart rate (HR) during acute ischemic stroke care predicts death. This finding highlights HR dynamics as a crucial prognostic indicator in stroke patients, guiding potential interventions.
Area of Science:
- Cardiology
- Neurology
- Clinical Medicine
Background:
- Resting heart rate (HR) is a known predictor of cardiovascular mortality.
- Continuous HR monitoring is standard in ischemic stroke care, but its acute phase dynamics and prognostic value are understudied.
Purpose of the Study:
- To investigate the prognostic value of heart rate (HR) dynamics during the acute phase of ischemic stroke.
- To identify HR patterns associated with mortality in ischemic stroke survivors.
Main Methods:
- Prospective observational study of 702 awake ischemic stroke patients surviving to discharge.
- Continuous electrocardiographic monitoring of HR during the first 72 hours post-admission.
- Functional outcome assessed at 90 days.
Main Results:
- Initial HR decline observed within 12 hours of admission.
- Survivors showed a continuous downward HR trend; non-survivors exhibited a secondary HR increase post-admission.
- A secondary HR increase during acute care independently predicted death (HR, 3.73; P = .005) after risk factor adjustment.
Conclusions:
- A secondary rise in HR during acute ischemic stroke care is an early indicator of fatality.
- This HR pattern may signify unfavorable sympathetic disinhibition.
- Further research is needed on targeted HR reduction strategies post-stroke.
Background:
Growing evidence suggests that the heart rate (HR) at rest is an independent predictor of cardiovascular mortality. In ischemic stroke, continuous monitoring of HR is the standard of care, but systematic data on its dynamics and prognostic value during the acute phase are limited.
Methods:
In this prospective observational study, HR was measured by continuous electrocardiographic monitoring on admission and during the first 72 hours of care among patients who were awake with ischemic stroke and survived until discharge. Functional outcome was assessed after 90 days.
Results:
Data from 702 consecutive patients were analyzed (median age, 73 years, 54% men). The time course of HR was initially characterized by a rapid decline during the first 12 hours after admission. Among patients who survived until day 90, this was followed by a continuous downward trend in HR, whereas death after discharge was associated with a secondary increase and a reversal point 12 hours after admission. After adjustment for established risk factors, this secondary increase during the acute period was an independent predictor of death (hazard ratio, 3.73; 95% confidence interval, 1.47-9.43; P = .005).
Conclusions:
A secondary rise of HR during care for acute ischemic stroke is an early sign of fatality and may represent a surrogate for an unfavorable sympathetic disinhibition. Further research is warranted to clarify the role of targeted HR reduction after ischemic stroke (http://clinicaltrials.gov/, unique identifier NCT01858779).
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