Heart rate monitoring on the stroke unit. What does heart beat tell about prognosis? An observational study

Abstract

BackgroundGuidelines recommend maintaining the heart rate (HR) of acute stroke patients within physiological limits; data on the frequency and predictors of significant deviations from these limits are scarce.MethodsDemographical data, stroke risk factors, NIH stroke scale score, lesion size and location, and ECG parameters were prospectively assessed in 256 patients with ischemic stroke. Patients were continuously monitored for at least 24 hours on a certified stroke unit. Tachycardia (HR ≥120 bpm) and bradycardia (HR <45 bpm) and cardiac rhythm (sinus rhythm or atrial fibrillation) were documented. We investigated the influence of risk factors on HR disturbances and their respective influence on dependence (modified Rankin Scale ≥ 3 after three months) and mortality.ResultsHR ≥120 bpm occurred in 39 patients (15%). Stroke severity (larger lesion size/higher NIHSS-score on admission), atrial fibrillation and HR on admission predicted its occurrence. HR <45 bpm occurred in 12 patients (5%) and was predicted by lower HR on admission. Neither HR ≥120 nor HR <45 bpm independently predicted poor outcome at three moths. Stroke location had no effect on the occurrence of HR violations. Clinical severity and age remained the only consistent predictors of poor outcome.ConclusionsSignificant tachycardia and bradycardia are frequent phenomena in acute stroke; however they do not independently predict clinical course or outcome. Continuous monitoring allows detecting rhythm disturbances in stroke patients and allows deciding whether urgent medical treatment is necessary.

Predictors of In-hospital Mortality of Acute Ischemic Stroke in Adult Population

“…The causes of higher admission pulse rate are the large stroke, severe stroke (NIHSS >15), and atrial fibrillation. [ 16 ] The data from this study corroborate with Böhm et al . who reported in their study that faster admission heart rate predicts the mortality and poor functional outcome in a patient with acute ischemic stroke.…”

Update to Practice Standards for Electrocardiographic Monitoring in Hospital Settings: A Scientific Statement From the American Heart Association

“…The incidence of these arrhythmias was highest in the first 24 hours and de clined over 3 days. 332 Ritter and colleagues 333 conducted a prospective study of 256 patients with ischemic strokes who were continuously monitored for at least 24 hours. In this study, 15% had episodes of a heart rate >120 bpm; this was associated with larger lesion size, higher National Institutes of Health Stroke Scale score, and AF.…”

Can we improve the early detection of atrial fibrillation in a stroke unit? Detection rate of a monitor with integrated detection software

“…After activation, the nursing staff performs a standard ECG and calls the neurologist to evaluate the patient's condition. 28,29 A recent meta-analysis of studies with varying durations of cardiac monitoring showed the overall detection rate of any AF after a transient ischaemic attack or a brain infarction was 11.5%, although there was high variability due to the varying sensitivities of the diagnostic tools. 21 The detection rate of inpatient cardiac monitoring in selected patients is 6.5-21.3%, 25,30,31 which is slightly lower than the 26.3% rate of AF in our study.…”