title: Prolonged elevated heart rate is a risk factor for adverse cardiac events and poor outcome after subarachnoid hemorrhage.
abstract: BACKGROUND
  Sympathetic nervous system hyperactivity is common after subarachnoid hemorrhage (SAH). We sought to determine whether uncontrolled prolonged heart rate elevation is a risk factor for adverse cardiopulmonary events and poor outcome after SAH.
  
  
  METHODS
  We prospectively studied 447 SAH patients between March 2006 and April 2012. Prior studies define prolonged elevated heart rate (PEHR) as heart rate >95 beats/min for >12 h. Major adverse cardiopulmonary events were documented according to the predefined criteria. Global outcome at 3 months was assessed with the modified Rankin Scale (mRS).
  
  
  RESULTS
  175 (39 %) patients experienced PEHR. Nonwhite race/ethnicity, admission Hunt-Hess grade ≥4, elevated APACHE-2 physiological subscore, and modified Fisher score were significant admission predictors of PEHR, whereas documented pre-hospital beta-blocker use was protective. After controlling for admission Hunt-Hess grade, Cox regression using time-lagged covariates revealed that PEHR onset in the previous 48 h was associated with an increased hazard for delayed cerebral ischemia, myocardial injury, and pulmonary edema. PEHR was associated with 3-month poor outcome (mRS 4-6) after controlling for known predictors.
  
  
  CONCLUSIONS
  PEHR is associated with major adverse cardiopulmonary events and poor outcome after SAH. Further study is warranted to determine if early sympatholytic therapy targeted at sustained heart rate control can improve outcome after SAH.
authors.affiliation: Department of Neurology, Columbia University Medical Center, 177 Fort Washington Avenue, Milstein Hospital, Suite 8-300, New York, NY, 10032, USA, mjs2134@columbia.edu.
authors.forename: J Michael
authors.initials: JM
authors.lastname: Schmidt
authors.forename: Michael
authors.initials: M
authors.lastname: Crimmins
authors.forename: Hector
authors.initials: H
authors.lastname: Lantigua
authors.forename: Andres
authors.initials: A
authors.lastname: Fernandez
authors.forename: Chris
authors.initials: C
authors.lastname: Zammit
authors.forename: Cristina
authors.initials: C
authors.lastname: Falo
authors.forename: Sachin
authors.initials: S
authors.lastname: Agarwal
authors.forename: Jan
authors.initials: J
authors.lastname: Claassen
authors.forename: Stephan A
authors.initials: SA
authors.lastname: Mayer
mesh_terms: D000208:Acute Disease; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D002545:Brain Ischemia / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology; D003244:Consciousness Disorders / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology; D004562:Electrocardiography; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D006973:Hypertension / Q000401:mortality* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D013345:Subarachnoid Hemorrhage / Q000401:mortality* / Q000503:physiopathology; D013564:Sympathetic Nervous System / Q000187:drug effects / Q000503:physiopathology*; D013610:Tachycardia / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology; D016896:Treatment Outcome; D020301:Vasospasm, Intracranial / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology
chemical_list: D000319:Adrenergic beta-Antagonists
references.citation: JAMA. 2002 Mar 20;287(11):1435-44
references.pmid: 11903031
references.citation: Neurology. 1994 May;44(5):815-20
references.pmid: 8190280
references.citation: Cerebrovasc Dis. 2008;26(1):71-8
references.pmid: 18525201
references.citation: Stroke. 2001 Sep;32(9):2012-20
references.pmid: 11546890
references.citation: Neurocrit Care. 2008;8(3):404-12
references.pmid: 18196475
references.citation: Circulation. 2005 Nov 1;112(18):2851-6
references.pmid: 16267258
references.citation: Neurosurgery. 2009 Mar;64(3):397-410; discussion 410-1
references.pmid: 19240601
references.citation: Curr Opin Crit Care. 2001 Oct;7(5):314-22
references.pmid: 11805528
references.citation: Neurosurgery. 1992 Jul;31(1):42-50; discussion 50-1
references.pmid: 1641109
references.citation: Lancet. 1993 Mar 20;341(8847):715-9
references.pmid: 8095624
references.citation: Stroke. 1991 Jun;22(6):746-9
references.pmid: 2057973
references.citation: Cardiovasc Res. 1975 Mar;9(2):236-45
references.pmid: 45651
references.citation: Crit Care Med. 2005 Jan;33(1):81-8; discussion 241-2
references.pmid: 15644652
references.citation: Stroke. 2000 Apr;31(4):901-6
references.pmid: 10753996
references.citation: Stroke. 2009 Feb;40(2):412-8
references.pmid: 19095990
references.citation: Eur J Clin Pharmacol. 1985;28 Suppl:25-9
references.pmid: 2865145
references.citation: Acta Neurol Scand. 2004 Oct;110(4):248-53
references.pmid: 15355489
references.citation: Circulation. 2005 Nov 22;112(21):3314-9
references.pmid: 16286583
references.citation: Intensive Care Med. 2006 Dec;32(12):1955-61
references.pmid: 17058068
references.citation: Crit Care Med. 2011 Oct;39(10):2330-6
references.pmid: 21666448
references.citation: J Neurol Neurosurg Psychiatry. 1995 May;58(5):614-7
references.pmid: 7745412
references.citation: J Trauma. 2007 Jan;62(1):26-33; discussion 33-5
references.pmid: 17215730
references.citation: Stroke. 1995 Nov;26(11):2027-30
references.pmid: 7482643
references.citation: Br Heart J. 1974 Jul;36(7):697-706
references.pmid: 4415138
references.citation: Stroke. 2009 Mar;40(3):994-1025
references.pmid: 19164800
references.citation: J Neurosurg Anesthesiol. 2008 Jul;20(3):188-92
references.pmid: 18580349