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.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1750-1756 |
| Number of pages | 7 |
| Journal | European Journal of Neurology |
| Volume | 23 |
| Issue number | 12 |
| DOIs | |
| State | Published - Dec 1 2016 |
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Keywords
- acute stroke
- heart failure
- heart rate
- mortality
- recurrent stroke
ASJC Scopus subject areas
- Neurology
- Clinical Neurology
Cite this
Impact of heart rate on admission on mortality and morbidity in acute ischaemic stroke patients – results from VISTA. / for the VISTA collaborators.
In: European Journal of Neurology, Vol. 23, No. 12, 01.12.2016, p. 1750-1756.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Impact of heart rate on admission on mortality and morbidity in acute ischaemic stroke patients – results from VISTA
AU - for the VISTA collaborators
AU - Nolte, C. H.
AU - Erdur, H.
AU - Grittner, U.
AU - Schneider, A.
AU - Piper, S. K.
AU - Scheitz, J. F.
AU - Wellwood, I.
AU - Bath, P. M W
AU - Diener, H. C.
AU - Lees, K. R.
AU - Endres, M.
AU - Alexandrov, A.
AU - Bluhmki, E.
AU - Bornstein, N.
AU - Chen, C.
AU - Claesson, L.
AU - Davis, S. M.
AU - Donnan, G.
AU - Fisher, M.
AU - Ginsberg, M.
AU - Ginsberg, Myron
AU - Grotta, J.
AU - Hacke, W.
AU - Hennerici, M. G.
AU - Hommel, M.
AU - Kaste, M.
AU - Lyden, P.
AU - Marler, J.
AU - Muir, K.
AU - Sacco, R.
AU - Sacco, Ralph L
AU - Teal, P.
AU - Venketasubramanian, N.
AU - Wahlgren, N. G.
AU - Warach, S.
AU - Weimar, C.
PY - 2016/12/1
Y1 - 2016/12/1
N2 - 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.
AB - 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.
KW - acute stroke
KW - heart failure
KW - heart rate
KW - mortality
KW - recurrent stroke
UR - http://www.scopus.com/inward/record.url?scp=84992455342&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84992455342&partnerID=8YFLogxK
U2 - 10.1111/ene.13115
DO - 10.1111/ene.13115
M3 - Article
C2 - 27516056
AN - SCOPUS:84992455342
VL - 23
SP - 1750
EP - 1756
JO - European Journal of Neurology
JF - European Journal of Neurology
SN - 1351-5101
IS - 12
ER -