Effect of Heart Rate Variabilities on Outcome After Acute Intracerebral Hemorrhage: A Post Hoc Analysis of ATACH‐2

Abstract

Background To explore how the clinical impact of heart rate (HR) and heart rate variabilities (HRV) during the initial 24 hours after acute intracerebral hemorrhage (ICH) contribute to worse clinical outcomes. Methods and Results In the ATACH‐2 (Antihypertensive Treatment in Intracerebral Hemorrhage 2) trial, the HR was recorded for every 15 minutes from baseline to 1 hour and hourly during the initial 24 hours post‐randomization. We calculated the following: mean, standard deviation, coefficient of variation, successive variation, and average real variability (ARV). Outcomes were hematoma expansion at 24 hours and unfavorable functional outcome, defined as modified Rankin Scale score 4 to 6 at 90 days. Of the 1000 subjects in ATACH‐2, 994 with available HR data were included in the analyses. Overall, 262 experienced hematoma expansion, and 362 had unfavorable outcomes. Increased mean HR was linearly associated with unfavorable outcome (per 10 bpm increase adjusted odds ratio [aOR], 1.31, 95% CI, 1.14–1.50) but not with hematoma expansion, while HR‐ARV was associated with hematoma expansion (aOR, 1.06, 95% CI, 1.01–1.12) and unfavorable outcome (aOR, 1.07, 95% CI, 1.01–1.3). Every 10‐bpm increase in mean HR increased the probability of unfavorable outcome by 4.3%, while every 1 increase in HR‐ARV increased the probability of hematoma expansion by 1.1% and unfavorable outcome by 1.3%. Conclusions Increased mean HR and HR‐ARV within the initial 24 hours were independently associated with unfavorable outcome in acute ICH. Moreover, HR‐ARV was associated with hematoma expansion at 24 hours. This may have future therapeutic implications to accommodate HR and HRV in acute ICH. Registration URL: https://www.clinicaltrials.gov ; Unique Identifier: NCT01176565.

Effect of mean heart rate on 30-day mortality in ischemic stroke with atrial fibrillation: Data from the MIMIC-IV database

“…Numerous studies have found that heart rate was associated with the prognosis of many diseases, including coronary heart disease, myocardial infarction, heart failure, acute ischemic stroke, acute hemorrhagic stroke, and so on ( 7 , 9 , 11 , 13 , 27 – 30 ). In addition, heart rate variability is associated with the incidence and duration of poststroke depression ( 27 ).…”

“…A fast heart rate may also indicate sympathetic nerve overactivity, which has been related to inflammatory processes and higher blood pressure at night, both of which are well-known indicators of stroke mortality ( 35 – 37 ). Previous studies on the relationship between heart rate variability and stroke outcomes have also found that patients with low heart rate variability have a worse prognosis, while low heart rate variability indicates high sympathetic nervous system activity ( 8 , 10 , 11 ). In addition to the increased sympathetic nervous system tone in the acute phase of stroke, Lee et al found a stronger association between mean heart rate and mortality in the late acute stage ( 13 ).…”

“…There is no consensus on which heart rate parameters or periods are best for the autonomic nervous system. Some studies employed heart rate parameters within a week after onset ( 14 ) and others within 24 h of admission ( 4 , 8 , 11 , 15 ), while yet other studies used heart rate parameters at the time of the patient's first admission ( 6 , 7 , 16 ). Previous studies have reported controversial associations between heart rate and stroke outcomes.…”

“…However, other studies have found that tachycardia and bradycardia do not independently predict the clinical course or outcome of stroke patients ( 18 ). The effect of heart rate variability on disease outcomes is also controversial ( 8 – 11 , 13 , 19 ).…”

Controlling blood pressure soon after intracerebral hemorrhage: The SAMURAI-ICH Study and its successors

“…Japanese researchers contributed to the ATACH-2 trial not only by patient recruitment but also by subanalyses using the ATACH-2 dataset. The themes of the subanalyses included sex differences [ 29 ], regional differences (Asia versus non-Asia) [ 30 ], late neurological deterioration [ 31 ], kidney function [ 32 ], heart rate [ 33 ], and the impacts of achieved SBP levels on clinical outcomes [ 34 ].…”