Heart rate on admission independently predicts in-hospital mortality in acute ischemic stroke patients ☆ Hebun Erdur a, ⁎, Jan F. Scheitz a,b,e , Ulrike Grittner b,c , Ulrich Laufs d , Matthias Endres a,b,e , Christian H. Nolte a,b a Department of Neurology, Charité — Universitätsmedizin Berlin, Germany b Center for Stroke Research, Charité — Universitätsmedizin Berlin, Germany c Department for Biostatistics and Clinical Epidemiology, Charité — Universitätsmedizin Berlin, Germany d Department of Cardiology, Universitätskliniken des Saarlandes, Homburg/Saar, Germany e NeuroCure, Cluster of Excellence, Charité — Universitätsmedizin Berlin, Germany abstract article info Article history: Received 5 November 2013 Received in revised form 16 April 2014 Accepted 5 July 2014 Available online xxxx Keywords: Heart rate Stroke Mortality Sympathetic nervous system Outcome Background: Higher heart rate (HR) is associated with worse outcomes – in particular death – in long term follow- up of patients with vascular diseases. We investigated the association between HR measured on admission and early in-hospital mortality in acute ischemic stroke patients. Methods: Over a period of 30 months all patients admitted to our hospital with acute ischemic stroke but without atrial fibrillation were prospectively enrolled. Univariate and multiple logistic regression analyses were conduct- ed to estimate the impact of HR on in-hospital mortality. HR was analyzed as continuous and categorical variable (tertiles). Results: A total of 1335 patients (median age 73 (IQR 65–81), median National Institutes of Health Stroke Scale score 4 (IQR 2–8), median length of stay 5 days (IQR 4–7), female sex 46%) were studied. In-hospital mortality was 2.6%. When analyzed as categorical variable, HR ≥ 83 bpm was independently associated with in-hospital mortality after adjustment for predictors of poor outcome compared to the reference tertile (HR ≤ 69 bpm) (ad- justed odds ratio 4.42, 95% CI 1.36–14.42, p = 0.01). When HR was modeled as continuous variable, relative risk for in-hospital death was elevated by 40% for every additional 10-bpm (p = 0.003). These results were not changed by including beta-blockers as covariate into the multiple regression model. Conclusions: HR on admission is independently associated with in-hospital mortality in acute ischemic stroke pa- tients suggesting early negative effects of autonomic imbalance. HR may represent a therapeutic target to im- prove outcome after ischemic stroke. © 2014 Elsevier Ireland Ltd. All rights reserved. 1. Introduction Retrospective analyses suggest that higher heart rate (HR) at rest is independently associated with total mortality in follow- up (≥3 months) of patients with ischemic stroke of non-cardioembolic origin [1,2]. A higher HR at rest is associated with increased mortality in long-term follow-up in the general population and in patients with arterial hypertension, coronary artery disease, and heart failure [3–6]. Furthermore, in patients with myocardial infarction and acute heart fail- ure, higher HR on admission was independently associated with higher in-hospital mortality [7,8]. Studies investigating the relation of HR on admission with very early outcome of patients with ischemic stroke are lacking. To date, studies investigating the effects of HR on outcome of pa- tients with ischemic stroke have mainly assessed (i) HR at rest and/or (ii) long-term outcome of at least three months after the index event. We investigated whether HR on admission was independently associat- ed with early in-hospital mortality in patients with acute ischemic stroke and without atrial fibrillation. We additionally examined whether HR on admission was indepen- dently associated with poor outcome (Modified Rankin Scale (mRS) ≥ 5), as in-hospital mortality as an outcome parameter is subject to re- strictions due to the possibility of withdrawal of care following patient and family preferences on life-sustaining measures [9]. 2. Methods 2.1. Study population and data acquisition This study is a retrospective analysis of prospectively collected data of all consecutive patients with acute ischemic stroke (n = 1766) admitted to our tertiary care hospital International Journal of Cardiology xxx (2014) xxx–xxx ☆ All authors state that they take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation. ⁎ Corresponding author at: Department of Neurology, Campus Benjamin Franklin, Charité – Universitätsmedizin Berlin, Hindenburgdamm 30, 12200 Berlin, Germany. Tel.: +49 30 84454285; fax: +49 30 84454264. E-mail address: hebun.erdur@charite.de (H. Erdur). IJCA-18319; No of Pages 5 http://dx.doi.org/10.1016/j.ijcard.2014.07.001 0167-5273/© 2014 Elsevier Ireland Ltd. All rights reserved. Contents lists available at ScienceDirect International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard Please cite this article as: Erdur H, et al, Heart rate on admission independently predicts in-hospital mortality in acute ischemic stroke patients, Int J Cardiol (2014), http://dx.doi.org/10.1016/j.ijcard.2014.07.001