Effect of Heart Rate on 1-Year Outcome for Patients With Acute Ischemic Stroke

Abstract

Background Previous literature about the effect of heart rate on poststroke outcomes is limited. We attempted to elucidate (1) whether heart rate during the acute period of ischemic stroke predicts subsequent major clinical events, (2) which heart rate parameter is best for prediction, and (3) what is the estimated heart rate cutoff point for the primary outcome. Methods and Results Eight thousand thirty-one patients with acute ischemic stroke who were hospitalized within 48 hours of onset were analyzed retrospectively. Heart rates between the 4th and 7th day after onset were collected and heart rate parameters including mean, time-weighted average, maximum, and minimum heart rate were evaluated. The primary outcome was the composite of recurrent stroke, myocardial infarction, and mortality up to 1 year after stroke onset. All heart rate parameters were associated with the primary outcome (P's<0.001). Maximum heart rate had the highest predictive power. The estimated cutoff point for the primary outcome was 81 beats per minute for mean heart rate and 100 beats per minute for maximum heart rate. Patients with heart rates above these cutoff points had a higher risk of the primary outcome (adjusted hazard ratio, 1.80 [95% CI, 1.57-2.06] for maximum heart rate and 1.65 [95% CI, 1.45-1.89] for mean heart rate). The associations were replicated in a separate validation dataset (N=10 000). Conclusions These findings suggest that heart rate during the acute period of ischemic stroke is a predictor of major clinical events, and optimal heart rate control might be a target for preventing subsequent cardiovascular events.

Keywords: acute ischemic stroke; cohort study; heart rate; prognosis.

Figure 1. Survival curve of primary and secondary outcomes by mean heart rate deciles.

A, Composite of stroke recurrence, myocardial infarction, and all‐cause mortality. B, All‐cause mortality. C, Stroke recurrence. D, Composite of stroke recurrence, myocardial infarction, and vascular death.

Figure 2. Association between heart rate parameters and outcomes.

A, Composite of stroke recurrence, myocardial infarction, and all‐cause mortality. B, All‐cause mortality. C, Stroke recurrence. D, Composite of stroke recurrence, myocardial infarction, and vascular death.