Aims

Increased heart rate has been associated with stroke risk and outcomes. The purpose of this study was to explore the long-term prognostic value of initial in-hospital heart rate in patients with acute ischemic stroke (AIS).

Methods

We analyzed data from 21,655 patients with AIS enrolled (January 2010–September 2018) in the Chang Gung Research Database. Mean initial in-hospital heart rates were averaged and categorized into 10-beat-per-minute (bpm) increments. The primary and secondary outcomes were all-cause mortality and cardiovascular death. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using multivariable adjusted Cox proportional hazard models, using the heart rate < 60 bpm subgroup as the reference.

Results

The adjusted HRs for all-cause mortality were 1.23 (95% CI 1.08–1.41) for heart rate 60–69 bpm, 1.74 (95% CI 1.53–1.97) for heart rate 70–79 bpm, 2.16 (95% CI 1.89–2.46) for heart rate 80–89 bpm, and 2.83 (95% CI 2.46–3.25) for heart rate ≥ 90 bpm compared with the reference group. Likewise, heart rate ≥ 60 bpm was also associated with an increased risk of cardiovascular death (adjusted HR 1.18 [95% CI 0.95–1.46] for heart rate 60–69 bpm, 1.57 [95% CI 1.28–1.93] for heart rate 70–79 bpm, 1.98 [95% CI 1.60–2.45] for heart rate 80–89 bpm, and 2.36 [95% CI 1.89–2.95] for heart rate ≥ 90 bpm).

Conclusions

High initial in-hospital heart rate is an independent predictor of all-cause mortality and cardiovascular death in patients with AIS.

Graphical abstract

中文翻译：

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初始住院心率与急性缺血性卒中患者的长期生存相关

目标

心率增加与中风风险和结局相关。本研究的目的是探讨初始院内心率对急性缺血性卒中 (AIS) 患者的长期预后价值。

方法

我们分析了长庚研究数据库中 21,655 名 AIS 患者的数据（2010 年 1 月至 2018 年 9 月）。平均初始住院心率被平均并分类为每分钟 10 次心跳 (bpm) 的增量。主要和次要结局是全因死亡率和心血管死亡。使用多变量调整的 Cox 比例风险模型估计风险比 (HR) 和 95% 置信区间 (CI)，使用心率 < 60 bpm 亚组作为参考。

结果

调整后的全因死亡率 HR 为 1.23 (95% CI 1.08–1.41)，心率 60–69 bpm，1.74 (95% CI 1.53–1.97)，心率 70–79 bpm，2.16 (95% CI 1.89–与参考组相比，心率 80-89 bpm 为 2.46），心率 ≥ 90 bpm 为 2.83（95% CI 2.46-3.25）。同样，心率 ≥ 60 bpm 也与心血管死亡风险增加相关（调整后的 HR 1.18 [95% CI 0.95–1.46] 心率 60–69 bpm，1.57 [95% CI 1.28–1.93] 心率 70 –79 bpm，心率 80-89 bpm 为 1.98 [95% CI 1.60-2.45]，心率 ≥ 90 bpm 为 2.36 [95% CI 1.89-2.95]。

结论

高初始住院心率是 AIS 患者全因死亡率和心血管死亡的独立预测因子。

图形概要