Effect of Heart Rate on Stroke Recurrence and Mortality in Acute Ischemic Stroke With Atrial Fibrillation

Keon Joo Lee, Beom Joon Kim, Moon Ku Han, Joon Tae Kim, Kang Ho Choi, Dong Ick Shin, Min Ju Yeo, Jae Kwan Cha, Dae Hyun Kim, Hyun Wook Nah, Dong Eog Kim, Wi Sun Ryu, Jong Moo Park, Kyusik Kang, Soo Joo Lee, Jae Guk Kim, Mi Sun Oh, Kyung Ho Yu, Byung Chul Lee, Keun Sik HongYong Jin Cho, Jay Chol Choi, Tai Hwan Park, Sang Soon Park, Jee Hyun Kwon, Wook Joo Kim, Jun Lee, Ji Sung Lee, Juneyoung Lee, Philip B. Gorelick, Hee Joon Bae

    Research output: Contribution to journalArticlepeer-review

    35 Citations (Scopus)


    Background and Purpose - There is a paucity of information about the role of resting heart rate in the prediction of outcome events in patients with ischemic stroke with atrial fibrillation. We aimed to investigate the relationships between the level and variability of heart rate in the acute stroke period and stroke recurrence and mortality after acute ischemic stroke in patients with atrial fibrillation. Methods - Acute patients with ischemic stroke who had atrial fibrillation and were hospitalized within 48 hours of stroke onset were identified from a multicenter prospective stroke registry database. The acute stroke period was divided into early (within 24 hours of hospitalization) and late (72 hours to 7 days from onset) stages, and data on heart rate in both stages were collected. Moreover, the level and variability of heart rate were assessed using mean values and coefficients of variation. Outcome events were prospectively monitored up to 1 year after the index stroke. Results - Among 2046 patients eligible for the early acute stage analysis, 102 (5.0%) had a stroke recurrence, and 440 (21.5%) died during the first year after stroke. A statistically significant nonlinear J-shaped association was observed between mean heart rate and mortality (P<0.04 for quadratic and overall effect) but not between mean heart rate and stroke recurrence (P>0.1 for quadratic and overall effect). The nonlinear and overall effects of the coefficients of variation of heart rate were not significant for all outcome variables. The same results were observed in the late acute stage analysis (n=1576). Conclusions - In patients with atrial fibrillation hospitalized for acute ischemic stroke, the mean heart rate during the acute stroke period was not associated with stroke recurrence but was associated with mortality (nonlinear, J-shaped association). The relationships between heart rate and outcomes were not observed with respect to heart rate variability.

    Original languageEnglish
    Pages (from-to)162-169
    Number of pages8
    Issue number1
    Publication statusPublished - 2020 Jan 1

    Bibliographical note

    Publisher Copyright:
    © 2019 American Heart Association, Inc.


    • atrial fibrillation
    • heart rate
    • mortality
    • myocardial infarction
    • recurrence

    ASJC Scopus subject areas

    • Clinical Neurology
    • Cardiology and Cardiovascular Medicine
    • Advanced and Specialised Nursing


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