Initial in-hospital heart rate is associated with long-term survival in patients with acute ischemic stroke
Jiann-Der Lee1, Ya-Wen Kuo2, Chuan-Pin Lee3
1Department of Neurology, Chiayi Chang Gung Memorial Hospital, Chiayi, and College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Insights
High initial heart rate in acute ischemic stroke (AIS) patients independently predicts higher mortality. Elevated heart rates significantly increase the risk of both all-cause and cardiovascular death following AIS.
Area of Science:
- Cardiology
- Neurology
- Clinical Research
Background:
- Elevated heart rate is linked to stroke risk and prognosis.
- Understanding the long-term impact of initial heart rate in acute ischemic stroke (AIS) is crucial for patient outcomes.
Purpose of the Study:
- To investigate the long-term prognostic significance of initial in-hospital heart rate in patients diagnosed with AIS.
- To determine the association between varying heart rate ranges and mortality risk post-AIS.
Main Methods:
- Analysis of data from 21,655 AIS patients (January 2010-September 2018).
- In-hospital heart rates were averaged and grouped into 10-beat-per-minute (bpm) increments.
- Multivariable adjusted Cox proportional hazard models were used to assess mortality outcomes, with heart rate <60 bpm as the reference.
Main Results:
- Higher initial heart rates were significantly associated with increased all-cause mortality.
- Adjusted Hazard Ratios (HRs) for all-cause mortality increased with heart rate: 1.23 (60-69 bpm), 1.74 (70-79 bpm), 2.16 (80-89 bpm), and 2.83 (≥90 bpm).
- Similarly, elevated heart rates (≥60 bpm) correlated with higher cardiovascular death risk, with adjusted HRs ranging from 1.18 to 2.36 across the defined heart rate categories.
Conclusions:
- Initial in-hospital heart rate is an independent predictor of mortality in AIS patients.
- Higher heart rates are associated with increased risks of both all-cause and cardiovascular death.
- These findings underscore the importance of monitoring heart rate in AIS management.
Aims:
Increased 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).
Methods:
We 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.
Results:
The 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).
Conclusions:
High initial in-hospital heart rate is an independent predictor of all-cause mortality and cardiovascular death in patients with AIS.
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