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

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

doi:10.1007/s00392-021-01953-5

Cited by 4 publications

(3 citation statements)

References 56 publications

(53 reference statements)

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“…Moreover, lower heart rates are associated with better functional outcomes in stroke recovery [25]. In our current study, heart rate for 65-74 years old is 83.3-87.6 and 76.9-80.6 for ≥75 years AIS-HF patients and comparable to other studies in AIS patients with poor outcomes [24,26,27]. The link between elevated heart rate and the observed stroke severity in our AIS-HF patient population may be due to the compensatory rise in heart rate mechanisms and their inability to compensate.…”

Section: Discussionsupporting

confidence: 84%

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Age Stratification in Acute Ischemic Stroke Patients with Heart Failure

Edrissi

Rathfoot

Knisely

et al. 2022

JCM

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Background and Purpose. Heart failure (HF) is considered one of the major risk factors associated with the severity of acute ischemic stroke(AIS). The risk factors associated with stroke severity in AIS with a history of HF is not fully understood. Methods. A prospectively maintained database from comprehensive stroke centers in PRISMA Health Upstate Sc, was analyzed for patients with AIS and a history of HF from January 2010 to 30 June 2016. The primary outcome was risk factors associated with a National Institute of Health Stroke Scale score (NIHSS) < 7 indicating lower severity and a score ≥ 7 indicating high severity for 65–74 age category and ≥75 years age category for AIS-HF patients. Univariate analysis was used to determine risk factors based on age categories and stroke severities, while multivariable analysis was used to adjust for the effect of confounding variables. Results: A total 367 AIS-HF patients were identified in this study, 113 patients were between 65–74 years old, while 254 patients were in the ≥75 years old age category. In the adjusted analysis for 65–74 age category, history of smoking (OR = 0.105, 95% Confidence interval (CI): 0.018–0.614, p = 0.012), triglycerides (Odd ratio(OR) = 0.993, 95% (CI): 0.987–0.999, p = 0.019), and International Normalized Ratio (INR) (OR = 0.454, 95% CI: 0.196–1.050, p = 0.045), and direct admission treatment (OR = 0.355, 95% CI: 0.137–0.920, p = 0.033) were associated with a lower stroke severity, elevated heart rate (OR = 1.032, 95% CI: 1.009–1.057, p = 0.007) was associated with a higher stroke severity. For the ≥75 years old age category, previous stroke (OR = 2.297, 95% CI: 1.171–9.852, p = 0.024), peripheral vascular disease (OR = 6.784, 95% CI: 1.242–37.065, p = 0.027), heart rate (OR = 1.035, 95% CI: 1.008–1.063, p = 0.012), and systolic blood pressure (OR = 1.023, 95% CI: 1.005–1.041, p = 0.012) were associated with a higher severe stroke severity. Conclusions: After adjusting for the effect of potential confounders, more risk factors were associated with a high severity of stroke among ≥75 years old compared with 65–74 years old AIS-HF patients. Elevated heart rate was an independent risk factor associated with stroke severity in 65–74 and ≥75 years old AIS-HF patients. Elevated heart rate and other identified risk factors should be managed to reduce stroke severity among elderly AIS-HF patients.

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Section: Discussionsupporting

confidence: 84%

“…The link between elevated heart rate and the observed stroke severity in our AIS-HF patient population may be due to the compensatory rise in heart rate mechanisms and their inability to compensate. A similar explanation was provided for the poor neurologic outcomes observed in AIS with elevated heart rates [26,28].…”

Section: Discussionmentioning

confidence: 68%

Age Stratification in Acute Ischemic Stroke Patients with Heart Failure

Edrissi

Rathfoot

Knisely

et al. 2022

JCM

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“…The ASTRAL score is one of the few prognostic scoring systems validated to predict poststroke long-term mortality and is based on six items: age, stroke severity, the time delay between symptom onset or last proof of good health (in the case of an unknown onset stroke) and admission, presence of any new visual field defect, glucose at admission, and level of consciousness [ 6 ]. Although stroke severity and age are crucial predictors of outcomes after acute ischemic stroke (AIS) [ 5 , 7 ], many other clinical factors are associated with poststroke mortality, especially long-term mortality [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Development and Validation of a Novel Score for Predicting Long-Term Mortality after an Acute Ischemic Stroke

Lin

Kuo

Huang

et al. 2023

IJERPH

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Background: Long-term mortality prediction can guide feasible discharge care plans and coordinate appropriate rehabilitation services. We aimed to develop and validate a prediction model to identify patients at risk of mortality after acute ischemic stroke (AIS). Methods: The primary outcome was all-cause mortality, and the secondary outcome was cardiovascular death. This study included 21,463 patients with AIS. Three risk prediction models were developed and evaluated: a penalized Cox model, a random survival forest model, and a DeepSurv model. A simplified risk scoring system, called the C-HAND (history of Cancer before admission, Heart rate, Age, eNIHSS, and Dyslipidemia) score, was created based on regression coefficients in the multivariate Cox model for both study outcomes. Results: All experimental models achieved a concordance index of 0.8, with no significant difference in predicting poststroke long-term mortality. The C-HAND score exhibited reasonable discriminative ability for both study outcomes, with concordance indices of 0.775 and 0.798. Conclusions: Reliable prediction models for long-term poststroke mortality were developed using information routinely available to clinicians during hospitalization.

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Assessment of the impact of resting heart rate on the risk of major adverse cardiovascular events after ischemic stroke: a retrospective observational study

Lin,

Zhang,

Kuo

et al. 2024

BMC Neurol

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Background Although elevated heart rate is a risk factor for cardiovascular morbidity and mortality in healthy people, the association between resting heart rate and major cardiovascular risk in patients after acute ischemic stroke remains debated. This study evaluated the association between heart rate and major adverse cardiovascular events after ischemic stroke. Methods We conducted a retrospective cohort study analyzing data from the Chang Gung Research Database for 21,655 patients with recent ischemic stroke enrolled between January 1, 2010, and September 30, 2018. Initial in-hospital heart rates were averaged and categorized into 10–beats per minute (bpm) increments. The primary outcome was the composite of hospitalization for recurrent ischemic stroke, myocardial infarction, or all-cause mortality. Secondary outcomes were hospitalization for recurrent ischemic stroke, myocardial infarction, and heart failure. Hazard ratios and 95% confidence intervals (CIs) were estimated using Cox proportional hazards models, using the heart rate < 60 bpm subgroup as the reference. Results After a median follow-up of 3.2 years, the adjusted hazard ratios for the primary outcome were 1.13 (95% CI: 1.01 to 1.26) for heart rate 60–69 bpm, 1.35 (95% CI: 1.22 to 1.50) for heart rate 70–79 bpm, 1.64 (95% CI: 1.47 to 1.83) for heart rate 80–89 bpm, and 2.08 (95% CI: 1.85 to 2.34) for heart rate ≥ 90 bpm compared with the reference group. Heart rate ≥ 70 bpm was associated with increased risk of all secondary outcomes compared with the reference group except heart failure. Conclusions Heart rate is a simple measurement with important prognostic implications. In patients with ischemic stroke, initial in-hospital heart rate was associated with major adverse cardiovascular events. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-024-03772-3.

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

Cited by 4 publications

References 56 publications

Age Stratification in Acute Ischemic Stroke Patients with Heart Failure

Age Stratification in Acute Ischemic Stroke Patients with Heart Failure

Development and Validation of a Novel Score for Predicting Long-Term Mortality after an Acute Ischemic Stroke

Assessment of the impact of resting heart rate on the risk of major adverse cardiovascular events after ischemic stroke: a retrospective observational study

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