Alexander E. Merkler, MD

Qiu M, Sato S, Zheng D, Wang X, Carcel C, Hirakawa Y, et al. Admission Heart Rate Predicts Poor Outcomes in Acute Intracerebral Hemorrhage: The Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial Studies. Stroke. 2016

Intracerebral hemorrhage is a devastating disease with a one-month mortality of 40%. Larger ICH volume, older age, and hematoma expansion are some of the factors associated with both poor functional outcome and death. Admission heart rate (HR) has previously been shown to predict higher mortality in coronary artery disease and ischemic stroke, but its impact on patients with ICH is unknown. 

In this study, Drs. Qiu et al perform a post-hoc analysis on data from the INTERACT trials to evaluate the effect of admission heart rate on outcome in ICH. Clinical outcomes included mortality and functional outcome (mRS) at 90 days. Imaging outcome was hematoma growth on 24 hour CT. HR was divided into quartiles (<65, 65-74, 75-84, ≥85) and Cox logistic regression was used to account for possible confounders in the relationship between admission HR and the outcomes of interest.

Of 3185 patients with ICH, patients with higher admission HR had higher BP, more frequent intraventricular extension of hematoma, and were less likely enrolled in China; patients with lower admission HR were more likely older, more often were taking a beta-blocker or antithrombotic, and had larger hematomas that were less likely to be in a lobar location.  Overall, higher admission HR was associated with higher mortality (adjusted hazard ratio for HR ≥85 vs. <65: 1.5; CI, 1.07-2.11). In addition, higher admission HR was associated with worse functional outcome at 90 days (adjusted odds ratio 1.33; CI 1.08-1.63). There was no significant association between admission HR and hematoma expansion on 24 hour CT.

Similar to coronary artery disease and ischemic stroke, admission HR appears to be associated with increased mortality and poor functional outcomes in patients with ICH. As the authors suggest, perhaps higher admission HR is a marker of poor general health, dehydration, anemia, or a marker of cardiac disease, all of which are predictors of poor outcome after stroke. One major limitation is the lack of adjustment for heart rate variability, which has also been shown to be associated with poor outcomes after stroke.  

In conclusion, admission HR is associated with increased mortality and poor functional outcome in patients with ICH.