Objective:

To evaluate the association between admission ECG-derived resting heart rate (RHR) and in-hospital all-cause mortality during the index hospitalization, and to examine the relationship according to atrial fibrillation (AF) status.

Approach:

• Data Collection: The first available 12-lead ECG-derived RHR recorded at rest was analyzed.
• Outcome Measurement: The primary outcome was in-hospital all-cause mortality, analyzed using multivariable logistic regression adjusted for relevant covariates.

Key Findings:

• The analytical cohort included 2,247 hospitalizations with a mean age of 68.4 years; 177 deaths occurred (7.9%).
• Each 10-beats/min increase in admission RHR was associated with 12% higher odds of in-hospital death (adjusted odds ratio 1.12, 95% confidence interval 1.06–1.20).
• Mortality was higher with RHR ≥ 76 beats/min (10.9%) compared to lower RHR (4.8%).
• In patients without AF, mortality was 9.0% with higher RHR vs. 3.6% with lower RHR; in patients with AF, it was 20.0% vs. 15.0%.

Interpretation:

Admission ECG-derived RHR was associated with all-cause in-hospital mortality in the acute-stroke cohort.

Limitations:

• Standardized stroke-severity measures were not uniformly available.
• Exact ECG timing and heart-rate-modifying medications were not consistently documented.
• Cause-specific mortality data were not available.

Conclusion:

The study highlights the potential of admission ECG-derived RHR as an early risk marker for in-hospital mortality in acute stroke patients.