title: Impact of heart rate on admission on mortality and morbidity in acute ischaemic stroke patients - results from VISTA.
abstract: 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.
  
  
  
  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).
  
  
  
  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)].
  
  
  
  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.
authors: Department of Neurology, Center for Stroke Research, Berlin Institute of Health, Charite-Universitätsmedzin, Berlin, Germany.|Centre for Stroke Research, Berlin, Germany.
authors: C H
authors: CH
authors: Nolte
authors: Department of Neurology, Center for Stroke Research, Berlin Institute of Health, Charite-Universitätsmedzin, Berlin, Germany.
authors: H
authors: H
authors: Erdur
authors: Centre for Stroke Research, Berlin, Germany.
authors: U
authors: U
authors: Grittner
authors: Centre for Stroke Research, Berlin, Germany.
authors: A
authors: A
authors: Schneider
authors: Centre for Stroke Research, Berlin, Germany.
authors: S K
authors: SK
authors: Piper
authors: Department of Neurology, Center for Stroke Research, Berlin Institute of Health, Charite-Universitätsmedzin, Berlin, Germany.|Centre for Stroke Research, Berlin, Germany.
authors: J F
authors: JF
authors: Scheitz
authors: Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
authors: I
authors: I
authors: Wellwood
authors: School of Medicine, University of Nottingham, Nottingham, UK.
authors: P M W
authors: PM
authors: Bath
authors: Klinik für Neurologie und Schlaganfall-Zentrum Universitätsklinikum, Essen, Germany.
authors: H-C
authors: HC
authors: Diener
authors: Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
authors: K R
authors: KR
authors: Lees
authors: Department of Neurology, Center for Stroke Research, Berlin Institute of Health, Charite-Universitätsmedzin, Berlin, Germany.|Centre for Stroke Research, Berlin, Germany.
authors: M
authors: M
authors: Endres
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000150:complications / Q000401:mortality* / Q000503:physiopathology; D002545:Brain Ischemia / Q000150:complications / Q000401:mortality* / Q000503:physiopathology; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D020521:Stroke / Q000150:complications / Q000401:mortality* / Q000503:physiopathology
keywords: acute stroke; heart failure; heart rate; mortality; recurrent stroke