C H Nolte1,2, H Erdur1, U Grittner2, A Schneider2, S K Piper2, J F Scheitz1,2, I Wellwood3, P M W Bath4, H-C Diener5, K R Lees6, M Endres1,2. 1. Department of Neurology, Center for Stroke Research, Berlin Institute of Health, Charite-Universitätsmedzin, Berlin, Germany. 2. Centre for Stroke Research, Berlin, Germany. 3. Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK. 4. School of Medicine, University of Nottingham, Nottingham, UK. 5. Klinik für Neurologie und Schlaganfall-Zentrum Universitätsklinikum, Essen, Germany. 6. Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
Abstract
BACKGROUND AND PURPOSE: Elevated heart rate (HR) is associated with worse outcomes in patients with cardiovascular disease. Its predictive value in acute stroke patients is less well established. We investigated the effects of HR on admission in acute ischaemic stroke patients. METHODS: Using the Virtual International Stroke Trials Archive (VISTA) database, the association between HR in acute stroke patients without atrial fibrillation and the pre-defined composite end-point of (recurrent) ischaemic stroke, transient ischaemic attack (TIA), myocardial infarction (MI) and vascular death within 90 days was analysed. Pre-defined secondary outcomes were the composite end-point components and any death, decompensated heart failure and degree of functional dependence according to the modified Rankin Scale after 90 days. HR was analysed as a categorical variable (quartiles). RESULTS: In all, 5606 patients were available for analysis (mean National Institutes of Health Stroke Scale 13; mean age 67 years; mean HR 77 bpm; 44% female) amongst whom the composite end-point occurred in 620 patients (11.1%). Higher HR was not associated with the composite end-point. The frequencies of secondary outcomes were 3.2% recurrent stroke (n = 179), 0.6% TIA (n = 35), 1.8% MI (n = 100), 6.8% vascular death (n = 384), 15.0% any death (n = 841) and 2.2% decompensated heart failure (n = 124). Patients in the highest quartile (HR> 86 bpm) were at increased risk for any death [adjusted hazard ratio (95% confidence interval) 1.40 (1.11-1.75)], decompensated heart failure [adjusted hazard ratio 2.20 (1.11-4.37)] and worse modified Rankin Scale [adjusted odds ratio 1.29 (1.14-1.52)]. CONCLUSIONS: In acute stroke patients, higher HR (>86 bpm) is linked to mortality, heart failure and higher degree of dependence after 90 days but not to recurrent stroke, TIA or MI.
BACKGROUND AND PURPOSE: Elevated heart rate (HR) is associated with worse outcomes in patients with cardiovascular disease. Its predictive value in acute strokepatients is less well established. We investigated the effects of HR on admission in acute ischaemic strokepatients. METHODS: Using the Virtual International Stroke Trials Archive (VISTA) database, the association between HR in acute strokepatients without atrial fibrillation and the pre-defined composite end-point of (recurrent) ischaemic stroke, transient ischaemic attack (TIA), myocardial infarction (MI) and vascular death within 90 days was analysed. Pre-defined secondary outcomes were the composite end-point components and any death, decompensated heart failure and degree of functional dependence according to the modified Rankin Scale after 90 days. HR was analysed as a categorical variable (quartiles). RESULTS: In all, 5606 patients were available for analysis (mean National Institutes of Health Stroke Scale 13; mean age 67 years; mean HR 77 bpm; 44% female) amongst whom the composite end-point occurred in 620 patients (11.1%). Higher HR was not associated with the composite end-point. The frequencies of secondary outcomes were 3.2% recurrent stroke (n = 179), 0.6% TIA (n = 35), 1.8% MI (n = 100), 6.8% vascular death (n = 384), 15.0% any death (n = 841) and 2.2% decompensated heart failure (n = 124). Patients in the highest quartile (HR> 86 bpm) were at increased risk for any death [adjusted hazard ratio (95% confidence interval) 1.40 (1.11-1.75)], decompensated heart failure [adjusted hazard ratio 2.20 (1.11-4.37)] and worse modified Rankin Scale [adjusted odds ratio 1.29 (1.14-1.52)]. CONCLUSIONS: In acute strokepatients, higher HR (>86 bpm) is linked to mortality, heart failure and higher degree of dependence after 90 days but not to recurrent stroke, TIA or MI.
Authors: Gessynger Morais-Silva; Willian Costa-Ferreira; Lucas Gomes-de-Souza; Jacqueline C Pavan; Carlos C Crestani; Marcelo T Marin Journal: Neurobiol Stress Date: 2019-06-06
Authors: Jason P Appleton; Lisa J Woodhouse; Daniel Bereczki; Eivind Berge; Hanne K Christensen; Rónán Collins; John Gommans; George Ntaios; Serefnur Ozturk; Szabolcs Szatmari; Joanna M Wardlaw; Nikola Sprigg; Peter M Rothwell; Philip M Bath Journal: Stroke Date: 2019-02 Impact factor: 7.914