Impact of resting heart rate on mortality, disability and cognitive decline in patients after ischaemic stroke

Michael Böhm, Daniel Cotton, Lydia Foster, Florian Custodis, Ulrich Laufs, Ralph L Sacco, Philip M W Bath, Salim Yusuf, Hans Christoph Diener

Research output: Contribution to journalArticle

63 Citations (Scopus)

Abstract

AimsRecurrent stroke is a frequent and disabling event. A high heart rate is associated with cardiovascular outcomes. We investigated the effects of the resting heart rate on cardiovascular and neurological outcomes after recurrent stroke in the high-risk population of the PRoFESS study.Methods and resultsA total of 20 165 patients after ischaemic stroke (mean age 66.1, SD 8.6 years) assigned to the treatment arms of the PRoFESS trial were pooled divided by quintiles of the baseline heart rate and analysed according to cardiovascular and functional outcomes after stroke: recurrent stroke and major cardiovascular outcomes such as stroke, myocardial infarction, and worsening or new-onset heart failure as well as death from cardiovascular and non-cardiovascular causes. Pre-defined endpoints were disability after a recurrent stroke, assessed with the modified Rankin scale (mRS) and the Barthel index at 3 months, and cognitive function, assessed with the Mini-Mental State Examination (MMSE) score at 4 weeks after randomization and at the penultimate visit. Patients in the two highest quintiles of heart rate (77-82 and >82 b.p.m.) were at a higher risk for total death [hazard ratio (HR) 1.42, 95 CI 1.19-1.69 and HR 1.74, 95 CI 1.48-2.06, P < 0.0001] compared with the lowest quintile. Similar results were observed for vascular death [71-≤76 b.p.m., HR 1.39 (1.11-1.74), P < 0.0001] and non-vascular death [from >82 b.p.m., HR 1.66 (1.29-2.13), P = 0.0016]. Myocardial infarction (P = 0.7084) and recurrent stroke (P = 0.1379) were not significantly associated with the baseline heart rate. Hazard ratios were adjusted to multiple confounders including the baseline blood pressure. In the group of patients with a recurrent stroke, an association of a lower heart rate to better outcomes was measured with the Barthel index across all heart rate groups. In addition, there was a significant association of the baseline heart rate to the occurrence of significant cognitive decline according to an MMSE score ≤24 points at 1 month and at the penultimate visit or a decline of <2 points between these two time periods. Better independence score at a low heart rate were observed.ConclusionThe heart rate is a risk indicator for mortality in patients with stroke and, importantly, a low heart rate is associated with a better functional outcome and less cognitive decline after an ischaemic stroke.Trial registration: ClinicalTrials.gov, number NTC00153062.

Original languageEnglish
Pages (from-to)2804-2812
Number of pages9
JournalEuropean Heart Journal
Volume33
Issue number22
DOIs
StatePublished - Nov 1 2012

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Heart Rate
Stroke
Mortality
Myocardial Infarction
Cognitive Dysfunction
Random Allocation
Cognition
Heart Failure
Blood Pressure
Population

Keywords

  • Cardiovascular outcomes
  • Cognitive decline
  • Dementia
  • Heart rate
  • Stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Impact of resting heart rate on mortality, disability and cognitive decline in patients after ischaemic stroke. / Böhm, Michael; Cotton, Daniel; Foster, Lydia; Custodis, Florian; Laufs, Ulrich; Sacco, Ralph L; Bath, Philip M W; Yusuf, Salim; Diener, Hans Christoph.

In: European Heart Journal, Vol. 33, No. 22, 01.11.2012, p. 2804-2812.

Research output: Contribution to journalArticle

Böhm, M, Cotton, D, Foster, L, Custodis, F, Laufs, U, Sacco, RL, Bath, PMW, Yusuf, S & Diener, HC 2012, 'Impact of resting heart rate on mortality, disability and cognitive decline in patients after ischaemic stroke', European Heart Journal, vol. 33, no. 22, pp. 2804-2812. https://doi.org/10.1093/eurheartj/ehs250
Böhm, Michael ; Cotton, Daniel ; Foster, Lydia ; Custodis, Florian ; Laufs, Ulrich ; Sacco, Ralph L ; Bath, Philip M W ; Yusuf, Salim ; Diener, Hans Christoph. / Impact of resting heart rate on mortality, disability and cognitive decline in patients after ischaemic stroke. In: European Heart Journal. 2012 ; Vol. 33, No. 22. pp. 2804-2812.
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AU - Laufs, Ulrich

AU - Sacco, Ralph L

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N2 - AimsRecurrent stroke is a frequent and disabling event. A high heart rate is associated with cardiovascular outcomes. We investigated the effects of the resting heart rate on cardiovascular and neurological outcomes after recurrent stroke in the high-risk population of the PRoFESS study.Methods and resultsA total of 20 165 patients after ischaemic stroke (mean age 66.1, SD 8.6 years) assigned to the treatment arms of the PRoFESS trial were pooled divided by quintiles of the baseline heart rate and analysed according to cardiovascular and functional outcomes after stroke: recurrent stroke and major cardiovascular outcomes such as stroke, myocardial infarction, and worsening or new-onset heart failure as well as death from cardiovascular and non-cardiovascular causes. Pre-defined endpoints were disability after a recurrent stroke, assessed with the modified Rankin scale (mRS) and the Barthel index at 3 months, and cognitive function, assessed with the Mini-Mental State Examination (MMSE) score at 4 weeks after randomization and at the penultimate visit. Patients in the two highest quintiles of heart rate (77-82 and >82 b.p.m.) were at a higher risk for total death [hazard ratio (HR) 1.42, 95 CI 1.19-1.69 and HR 1.74, 95 CI 1.48-2.06, P < 0.0001] compared with the lowest quintile. Similar results were observed for vascular death [71-≤76 b.p.m., HR 1.39 (1.11-1.74), P < 0.0001] and non-vascular death [from >82 b.p.m., HR 1.66 (1.29-2.13), P = 0.0016]. Myocardial infarction (P = 0.7084) and recurrent stroke (P = 0.1379) were not significantly associated with the baseline heart rate. Hazard ratios were adjusted to multiple confounders including the baseline blood pressure. In the group of patients with a recurrent stroke, an association of a lower heart rate to better outcomes was measured with the Barthel index across all heart rate groups. In addition, there was a significant association of the baseline heart rate to the occurrence of significant cognitive decline according to an MMSE score ≤24 points at 1 month and at the penultimate visit or a decline of <2 points between these two time periods. Better independence score at a low heart rate were observed.ConclusionThe heart rate is a risk indicator for mortality in patients with stroke and, importantly, a low heart rate is associated with a better functional outcome and less cognitive decline after an ischaemic stroke.Trial registration: ClinicalTrials.gov, number NTC00153062.

AB - AimsRecurrent stroke is a frequent and disabling event. A high heart rate is associated with cardiovascular outcomes. We investigated the effects of the resting heart rate on cardiovascular and neurological outcomes after recurrent stroke in the high-risk population of the PRoFESS study.Methods and resultsA total of 20 165 patients after ischaemic stroke (mean age 66.1, SD 8.6 years) assigned to the treatment arms of the PRoFESS trial were pooled divided by quintiles of the baseline heart rate and analysed according to cardiovascular and functional outcomes after stroke: recurrent stroke and major cardiovascular outcomes such as stroke, myocardial infarction, and worsening or new-onset heart failure as well as death from cardiovascular and non-cardiovascular causes. Pre-defined endpoints were disability after a recurrent stroke, assessed with the modified Rankin scale (mRS) and the Barthel index at 3 months, and cognitive function, assessed with the Mini-Mental State Examination (MMSE) score at 4 weeks after randomization and at the penultimate visit. Patients in the two highest quintiles of heart rate (77-82 and >82 b.p.m.) were at a higher risk for total death [hazard ratio (HR) 1.42, 95 CI 1.19-1.69 and HR 1.74, 95 CI 1.48-2.06, P < 0.0001] compared with the lowest quintile. Similar results were observed for vascular death [71-≤76 b.p.m., HR 1.39 (1.11-1.74), P < 0.0001] and non-vascular death [from >82 b.p.m., HR 1.66 (1.29-2.13), P = 0.0016]. Myocardial infarction (P = 0.7084) and recurrent stroke (P = 0.1379) were not significantly associated with the baseline heart rate. Hazard ratios were adjusted to multiple confounders including the baseline blood pressure. In the group of patients with a recurrent stroke, an association of a lower heart rate to better outcomes was measured with the Barthel index across all heart rate groups. In addition, there was a significant association of the baseline heart rate to the occurrence of significant cognitive decline according to an MMSE score ≤24 points at 1 month and at the penultimate visit or a decline of <2 points between these two time periods. Better independence score at a low heart rate were observed.ConclusionThe heart rate is a risk indicator for mortality in patients with stroke and, importantly, a low heart rate is associated with a better functional outcome and less cognitive decline after an ischaemic stroke.Trial registration: ClinicalTrials.gov, number NTC00153062.

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KW - Cognitive decline

KW - Dementia

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KW - Stroke

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