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

Author:

Lee Keon‐Joo12ORCID,Kim Beom Joon1ORCID,Han Moon‐Ku1ORCID,Kim Joon‐Tae3,Choi Kang‐Ho3ORCID,Shin Dong‐Ick4,Cha Jae‐Kwan5ORCID,Kim Dae‐Hyun5,Kim Dong‐Eog6,Ryu Wi‐Sun67ORCID,Park Jong‐Moo8,Kang Kyusik9ORCID,Lee Soo Joo10ORCID,Kim Jae Guk10ORCID,Oh Mi‐Sun11ORCID,Yu Kyung‐Ho11ORCID,Lee Byung‐Chul11ORCID,Hong Keun‐Sik12,Cho Yong‐Jin12ORCID,Choi Jay Chol13ORCID,Park Tai Hwan14ORCID,Park Sang‐Soon14,Lee Kyung Bok15ORCID,Kwon Jee‐Hyun16ORCID,Kim Wook‐Joo16,Sohn Sung Il17ORCID,Hong Jeong‐Ho17ORCID,Lee Jun18,Lee Ji Sung19ORCID,Lee Juneyoung20ORCID,Gorelick Philip B.21ORCID,Bae Hee‐Joon1ORCID,

Affiliation:

1. Department of Neurology Seoul National University Bundang Hospital Seongnam Korea

2. Department of Neurology Korea University Guro Hospital Seoul Korea

3. Department of Neurology Chonnam National University Hospital Gwangju Korea

4. Department of Neurology Chungbuk National University & Hospital Cheongju Korea

5. Department of Neurology Dong‐A University Hospital Busan Korea

6. Department of Neurology Dongguk University Ilsan Hospital Goyang Korea

7. Artificial Intelligence Research Center JLK Inc. Seoul Korea

8. Department of Neurology Uijeongbu Eulji Medical CenterEulji University Seoul Korea

9. Department of Neurology Nowon Eulji Medical CenterEulji University School of Medicine Seoul Korea

10. Department of Neurology Eulji University Hospital Daejeon Korea

11. Department of Neurology Hallym University Sacred Heart Hospital Anyang Korea

12. Department of Neurology Inje University Ilsan Paik Hospital Goyang Korea

13. Department of Neurology Jeju National University Hospital Jeju Korea

14. Department of Neurology Seoul Medical Center Seoul Korea

15. Department of Neurology Soonchunhyang University HospitalCollege of Medicine Seoul Korea

16. Department of Neurology Ulsan University Hospital Ulsan University College of Medicine Ulsan Korea

17. Department of Neurology Keimyung University Dongsan Medical Center Daegu Korea

18. Department of Neurology Yeungnam University Medical Center Daegu Korea

19. Clinical Research Center Asan Medical Center Seoul Korea

20. Department of Biostatistics Korea University Seoul Korea

21. Davee Department of Neurology Northwestern University Feinberg School of Medicine Chicago IL

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.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Cardiology and Cardiovascular Medicine

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