High resting heart rate is associated with cardiovascular death in patients with stroke, independent of sex.

BACKGROUND High resting heart rate (HRHR) is a surrogate marker of increased sympathetic outflow. In acute stroke patients, HRHR is more commonly observed in women than in men. We analysed whether HRHR (>86 bpm) adds incremental prognostic value for stroke outcomes in women. METHODS We analysed data of 6024 patients (2568 women, mean age 68.98 years) with acute ischemic stroke from the Virtual International Stroke Trials Archive (VISTA). RESULTS Patients with HRHR were more often female (45.3 vs 41.8%, p = 0.017), younger (66.0±13.2 vs. 67.8±12.6 years, p<0.001), had higher baseline systolic blood pressure and more often diabetes. The primary composite endpoint of recurrent ischemic stroke, transient ischemic attack, myocardial infarction, or cardiovascular death within 90 days occurred more often in patients with HRHR (19.3 vs. 14.6%, p <0.001). HRHR was associated with worse functional outcome at 90 days as assessed by modified Rankin Scale (mRS90: 3.03±1.98 vs. 2.82±1.94, p = 0.001). As exclusion of deceased patients (mRS90 of 6) resulted in a loss of association of HRHR with mRS90, it can be assumed that HRHR is mainly associated with post-stroke vascular mortality, but not disability. Female sex was not associated with the primary endpoint but with adverse functional outcome measured by mRS90. CONCLUSION HRHR was associated with adverse events and mortality after stroke. Despite a higher prevalence of HRHR in women, they did not reach the primary endpoint more often. However, women had a worse functional outcome (mRS) three months after stroke, independent of HRHR.