Persistent Beta‐Blocker Therapy Reduces Long‐Term Mortality in Patients With Acute Ischemic Stroke With Elevated Heart Rates
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...
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| Published in | Journal of the American Heart Association Vol. 14; no. 6; p. e039678 |
|---|---|
| Main Authors | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
England
John Wiley and Sons Inc
18.03.2025
Wiley |
| Subjects | |
| Online Access | Get full text |
| ISSN | 2047-9980 2047-9980 |
| DOI | 10.1161/JAHA.124.039678 |
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| Abstract | 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. |
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| AbstractList | 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. 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.BACKGROUNDElevated 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.METHODS AND RESULTSThis 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.CONCLUSIONSOur study shows that continuation of beta-blocker therapy in patients with acute ischemic stroke with tachycardia significantly reduces long-term mortality. Background 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. Methods and Results 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. Conclusions Our study shows that continuation of beta‐blocker therapy in patients with acute ischemic stroke with tachycardia significantly reduces long‐term mortality. |
| Author | Lee, Jun Hong, Keun‐Sik Lee, Ji Sung Lee, Soo Joo Park, Jong‐Moo Kim, Joon‐Tae Kim, Beom Joon Kang, Kyusik Kim, Jae Guk Roh, Seung‐Young Cho, Yong‐Jin Lee, Byung‐Chul Han, Moon‐Ku Kim, Do Yeon Kim, Wook‐Joo Shin, Dong‐Ick Kwon, Jee‐Hyun Guk, Hyung Seok Yu, Kyung‐Ho Gorelick, Philip B. Choi, Kang‐Ho Lee, Juneyoung Kim, Seong‐Eun Cha, Jae‐Kwan Choi, Jay Chol Lee, Keon‐Joo Kim, Dong‐Eog Bae, Hee‐Joon Kim, Dae‐Hyun Oh, Mi‐Sun Sohn, Sung Il Park, Sang‐Soon Park, Tai Hwan Ryu, Wi‐Sun Hong, Jeong‐Ho Lee, Kyung Bok |
| AuthorAffiliation | 22 Davee Department of Neurology, Division of Stroke and Neurocritical Care and Simpson Querrey Neurovascular Research Laboratory Northwestern University Feinberg School of Medicine Chicago Illinois USA 6 Department of Neurology Dongguk University Ilsan Hospital Goyang Korea 14 Department of Neurology Ulsan University Hospital Ulsan Korea 17 Department of Neurology Keimyung University Dongsan Medical Center Daegu Republic of Korea 12 Department of Neurology Jeju National University Hospital Jeju Korea 1 Department of Neurology Korea University Guro Hospital Seoul Korea 11 Department of Neurology Inje University Ilsan Paik Hospital Goyang Korea 18 Artificial Intelligence Research Center, JLK Inc. Seoul Korea 7 Department of Neurology Uijeongbu Eulji Hospital, Eulji University Seoul Korea 8 Department of Neurology Nowon Eulji Hospital, Eulji University Seoul Korea 16 Department of Neurology Soonchunhyang University Hospital, College of Medicine Seoul Korea 19 Department of Cardiology Korea Universi |
| AuthorAffiliation_xml | – name: 1 Department of Neurology Korea University Guro Hospital Seoul Korea – name: 9 Department of Neurology Eulji University Hospital Daejeon Korea – name: 11 Department of Neurology Inje University Ilsan Paik Hospital Goyang Korea – name: 2 Department of Neurology Seoul National University Bundang Hospital Seongnam Korea – name: 10 Department of Neurology Hallym University Sacred Heart Hospital Anyang Korea – name: 19 Department of Cardiology Korea University Guro Hospital Seoul Korea – name: 22 Davee Department of Neurology, Division of Stroke and Neurocritical Care and Simpson Querrey Neurovascular Research Laboratory Northwestern University Feinberg School of Medicine Chicago Illinois USA – name: 18 Artificial Intelligence Research Center, JLK Inc. Seoul Korea – name: 13 Department of Neurology Seoul Medical Center Seoul Korea – name: 20 Clinical Research Center Asan Medical Center Seoul Korea – name: 15 Department of Neurology Yeungnam University Medical Center Daegu Korea – name: 4 Department of Neurology Chungbuk National University & Hospital Cheongju Korea – name: 8 Department of Neurology Nowon Eulji Hospital, Eulji University Seoul Korea – name: 17 Department of Neurology Keimyung University Dongsan Medical Center Daegu Republic of Korea – name: 5 Department of Neurology Dong‐A University Hospital Busan Korea – name: 14 Department of Neurology Ulsan University Hospital Ulsan Korea – name: 21 Department of Biostatistics Korea University Seoul Korea – name: 7 Department of Neurology Uijeongbu Eulji Hospital, Eulji University Seoul Korea – name: 12 Department of Neurology Jeju National University Hospital Jeju Korea – name: 16 Department of Neurology Soonchunhyang University Hospital, College of Medicine Seoul Korea – name: 3 Department of Neurology Chonnam National University Hospital Gwangju Korea – name: 6 Department of Neurology Dongguk University Ilsan Hospital Goyang Korea |
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| Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Supplemental Material is available at https://www.ahajournals.org/doi/suppl/10.1161/JAHA.124.039678 This article was sent to Luciano A. Sposato, MD, MBA, FRCPC, Associate Editor, for review by expert referees, editorial decision, and final disposition. For Disclosures, see page 11. |
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| Snippet | 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... Background Elevated heart rate in patients with acute ischemic stroke is associated with increased risk of mortality. Beta‐blocker therapy is well known to... |
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| SubjectTerms | 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 |
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| Title | Persistent Beta‐Blocker Therapy Reduces Long‐Term Mortality in Patients With Acute Ischemic Stroke With Elevated Heart Rates |
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