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Prolonged Elevated Heart Rate is a Risk Factor for Adverse Cardiac Events and Poor Outcome after Subarachnoid Hemorrhage

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Abstract

Introduction

Sympathetic nervous system hyperactivity is common after subarachnoid hemorrhage (SAH). We sought to determine whether uncontrolled prolonged heart rate elevation is a risk factor for adverse cardiopulmonary events and poor outcome after SAH.

Methods

We prospectively studied 447 SAH patients between March 2006 and April 2012. Prior studies define prolonged elevated heart rate (PEHR) as heart rate >95 beats/min for >12 h. Major adverse cardiopulmonary events were documented according to the predefined criteria. Global outcome at 3 months was assessed with the modified Rankin Scale (mRS).

Results

175 (39 %) patients experienced PEHR. Nonwhite race/ethnicity, admission Hunt–Hess grade ≥4, elevated APACHE-2 physiological subscore, and modified Fisher score were significant admission predictors of PEHR, whereas documented pre-hospital beta-blocker use was protective. After controlling for admission Hunt–Hess grade, Cox regression using time-lagged covariates revealed that PEHR onset in the previous 48 h was associated with an increased hazard for delayed cerebral ischemia, myocardial injury, and pulmonary edema. PEHR was associated with 3-month poor outcome (mRS 4–6) after controlling for known predictors.

Conclusions

PEHR is associated with major adverse cardiopulmonary events and poor outcome after SAH. Further study is warranted to determine if early sympatholytic therapy targeted at sustained heart rate control can improve outcome after SAH.

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Acknowledgments

The project described was supported in part by a research grant from Baxter Healthcare™. The sponsors had no involvement in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication. Additional support was provided by the Charles A. Dana Foundation (SAM) and by the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant Number KL2 TR000081, formerly the National Center for Research Resources, Grant Number KL2 RR024157 (JMS). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

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Authors and Affiliations

  1. Department of Neurology, Columbia University Medical Center, 177 Fort Washington Avenue, Milstein Hospital, Suite 8-300, New York, NY, 10032, USA

    J. Michael Schmidt, Michael Crimmins, Hector Lantigua, Andres Fernandez, Chris Zammit, Cristina Falo, Sachin Agarwal, Jan Claassen & Stephan A. Mayer

  2. Department of Neurosurgery, Columbia University Medical Center, 177 Fort Washington Avenue, Milstein Hospital, Suite 8-300, New York, NY, 10032, USA

    Sachin Agarwal, Jan Claassen & Stephan A. Mayer

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  1. J. Michael Schmidt
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  2. Michael Crimmins
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  3. Hector Lantigua
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  4. Andres Fernandez
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  5. Chris Zammit
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  6. Cristina Falo
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  7. Sachin Agarwal
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  8. Jan Claassen
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  9. Stephan A. Mayer
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Correspondence to J. Michael Schmidt.

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Schmidt, J.M., Crimmins, M., Lantigua, H. et al. Prolonged Elevated Heart Rate is a Risk Factor for Adverse Cardiac Events and Poor Outcome after Subarachnoid Hemorrhage. Neurocrit Care 20, 390–398 (2014). https://doi.org/10.1007/s12028-013-9909-z

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  • DOI: https://doi.org/10.1007/s12028-013-9909-z

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