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

In contradistinction to blood pressure, where there are specific guidelines for management of this metric after acute ischemic stroke (AIS), guidance for the management of heart rate after AIS is not well established.

We attempted to elucidate whether heart rate during the acute period of ischemic stroke predicts subsequent major clinical events, which heart rate parameter is best for prediction, and what is the estimated heart rate cutoff point for the primary outcome. In a recent analysis that we carried out for patients with AIS and atrial fibrillation (AF), heart rate during the acute period was associated with poststroke mortality.

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).

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.

What Is New?

In this retrospective analysis of 8031 acute ischemic stroke cases, heart rate between the

fourth and seventh day after stroke onset was nonlinearly associated with the composite of recurrent stroke, myocardial infarction, and death.

Maximum heart rate had the best predictive power for adverse events.

Maximum heart rate of 100 beats per minute and mean rate of 81 beats per minute were determined as cutoffs.

What Are the Clinical Implications?

Heart rate during the acute period of ischemic stroke was associated with future adverse cardiovascular events.

A specific cutoff could be implemented in clinical practice or clinical trials.

SCAC 07/22 CAR 002 MPAD

J Am Heart Assoc. 2022;11:e025861. DOI: 10.1161/JAHA.122.025861