Persistent Beta‐Blocker Therapy Reduces Long‐Term Mortality in Patients With Acute Ischemic Stroke With Elevated Heart Rates

• Published in: Journal of the American Heart Association Vol. 14; no. 6; p. e039678
• Main Authors: Lee, Keon‐Joo, Kim, Seong‐Eun, Guk, Hyung Seok, Kim, Do Yeon, Kim, Beom Joon, Han, Moon‐Ku, Kim, Joon‐Tae, Choi, Kang‐Ho, Shin, Dong‐Ick, Cha, Jae‐Kwan, Kim, Dae‐Hyun, Kim, Dong‐Eog, Park, Jong‐Moo, Kang, Kyusik, Lee, Soo Joo, Kim, Jae Guk, Oh, Mi‐Sun, Yu, Kyung‐Ho, Lee, Byung‐Chul, Hong, Keun‐Sik, Cho, Yong‐Jin, Choi, Jay Chol, Park, Tai Hwan, Park, Sang‐Soon, Kwon, Jee‐Hyun, Kim, Wook‐Joo, Lee, Jun, Lee, Kyung Bok, Sohn, Sung Il, Hong, Jeong‐Ho, Ryu, Wi‐Sun, Roh, Seung‐Young, Lee, Ji Sung, Lee, Juneyoung, Gorelick, Philip B., Bae, Hee‐Joon
• Format: Journal Article
• Language: English
• Published: England John Wiley and Sons Inc 18.03.2025; Wiley
• Subjects: Adrenergic beta-Antagonists - therapeutic use; Aged; beta blocker; Female; heart rate; Heart Rate - drug effects; Humans; ischemic stroke; Ischemic Stroke - diagnosis; Ischemic Stroke - drug therapy; Ischemic Stroke - mortality; Ischemic Stroke - physiopathology; Male; Middle Aged; Myocardial Infarction - mortality; Myocardial Infarction - prevention & control; Original Research; Recurrence; Risk Factors; Secondary Prevention; Stroke - drug therapy; Stroke - mortality; Time Factors; Treatment Outcome; beta blocker; heart rate; ischemic stroke
• ISSN: 2047-9980; 2047-9980
• DOI: 10.1161/JAHA.124.039678

Elevated heart rate in patients with acute ischemic stroke is associated with increased risk of mortality. Beta-blocker therapy is well known to reduce heart rate. This study was a post hoc analysis of patients with acute ischemic stroke with maximum heart rates ≥100 bpm. Beta-blocker use, assessed on the eighth day after the index stroke, was categorized as persistent or nonpersistent based on usage up to 39 months. The primary outcome was a composite of stroke recurrence, myocardial infarction, and mortality within the first year. Long-term mortality, a secondary outcome, was tracked for up to 10 years. Among 5049 patients (women, 38%; mean age, 68.5 years), 32.1% were prescribed beta blockers by the eighth day after stroke, and 99% had prior beta-blocker use. One-year cumulative incidences of the primary outcome, stroke recurrence, and death were 27.8%, 3.5%, and 25.8%, respectively. Persistent beta-blocker use was associated with a significant reduction in the primary outcome (adjusted hazard ratio [HR], 0.81 [95% CI, 0.68-0.97]) and mortality (adjusted HR, 0.80 [95% CI, 0.69-0.94]) from 2 months to 1 year. Extended analysis of mortality for up to 10 years showed long-term benefits of beta-blocker use. Analyses subdividing patients into persistent users, discontinuers, and never-users suggested higher early mortality risk among discontinuers and potential late survival benefits for persistent users. Subgroup analyses demonstrated greater benefits in patients <75 years, and those with atrial fibrillation, coronary heart disease, and higher mean heart rates. Our study shows that continuation of beta-blocker therapy in patients with acute ischemic stroke with tachycardia significantly reduces long-term mortality.