{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T06:05:41Z","timestamp":1784009141043,"version":"3.55.0"},"reference-count":14,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T00:00:00Z","timestamp":1783987200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Early triage after acute stroke requires markers that are immediately available and clinically interpretable. The prognostic value of a single admission electrocardiogram (ECG)-derived resting heart rate (RHR), especially by atrial fibrillation (AF) status, remains insufficiently described.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a multicenter retrospective cohort study of adults hospitalized with ischemic stroke, hemorrhagic stroke, or transient ischemic attack at five tertiary hospitals in Palestine between January 2018 and January 2025. The exposure was the first available 12-lead ECG-derived RHR recorded at rest. The primary outcome was in-hospital all-cause mortality. Multivariable logistic regression adjusted for age, sex, hypertension, diabetes mellitus, ischemic heart disease, smoking, prior stroke, AF, and stroke subtype.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The analytical cohort included 2,247 index hospitalizations (mean age 68.4 \u00b1 13.6 years; 57.3% male), and 177 deaths occurred during hospitalization (7.9%). AF was present in 315 admissions (14.0%). 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\u20131.20;\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.001). Descriptively, mortality was higher with RHR \u2265 76 beats\/min than with lower RHR (10.9% vs. 4.8%). In rhythm-stratified descriptive analyses, this separation was clearer without AF (9.0% vs. 3.6%; crude odds ratio 2.65, 95% confidence interval 1.78\u20133.96) than with AF (20.0% vs. 15.0%; crude odds ratio 1.42, 95% confidence interval 0.77\u20132.61).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Admission ECG-derived RHR was associated with all-cause in-hospital mortality in this multicenter acute-stroke cohort. Because standardized stroke-severity measures, exact ECG timing, heart-rate-modifying medications, and cause-specific mortality were not uniformly available, this association should be interpreted as pragmatic early risk information rather than evidence that RHR is an independent causal determinant or therapeutic target.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1845558","type":"journal-article","created":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T05:37:22Z","timestamp":1784007442000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Admission ECG-derived resting heart rate and in-hospital mortality after acute stroke: a multicenter retrospective cohort study"],"prefix":"10.3389","volume":"13","author":[{"given":"Salahaldeen","family":"Deeb","sequence":"first","affiliation":[{"name":"Faculty of Medicine, Al-Quds University","place":["Jerusalem, Palestine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alhareth M.","family":"Amro","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Al-Quds University","place":["Jerusalem, Palestine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anas","family":"Ishqair","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Al-Quds University","place":["Jerusalem, Palestine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmad","family":"Nasereddin","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Al-Quds University","place":["Jerusalem, Palestine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad","family":"Ishqair","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Al-Quds University","place":["Jerusalem, Palestine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohanad","family":"Samaheen","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Al-Quds University","place":["Jerusalem, Palestine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naser","family":"Amro","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Al-Quds University","place":["Jerusalem, Palestine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdelwadod","family":"Abuturki","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Al-Ahli Hospital","place":["Hebron, Palestine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharif","family":"Basal","sequence":"additional","affiliation":[{"name":"Interventional Neuroradiology Unit, Al-Ahli Hospital","place":["Hebron, Palestine"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,14]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"132","DOI":"10.1177\/17474930241308142","article-title":"World stroke organization: global stroke fact sheet 2025.","volume":"20","author":"Feigin","year":"2025","journal-title":"Int J Stroke"},{"key":"B2","doi-asserted-by":"publisher","first-page":"e0277848","DOI":"10.1371\/journal.pone.0277848","article-title":"Can resting heart rate explain the heart rate and parasympathetic responses during rest, exercise, and recovery?","volume":"17","author":"Garcia","year":"2022","journal-title":"PLoS One"},{"key":"B3","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1186\/s13054-020-02885-8","article-title":"Brain-heart interaction after acute ischemic stroke.","volume":"24","author":"Battaglini","year":"2020","journal-title":"Crit Care"},{"key":"B4","doi-asserted-by":"publisher","first-page":"553","DOI":"10.1007\/s10286-025-01120-0","article-title":"Autonomic dysfunction after stroke: an overview of recent clinical evidence and perspectives on therapeutic management.","volume":"35","author":"Barkhudaryan","year":"2025","journal-title":"Clin Auton Res"},{"key":"B5","doi-asserted-by":"publisher","first-page":"222","DOI":"10.1186\/s12883-021-02252-2","article-title":"Initial in-hospital heart rate is associated with three-month functional outcomes after acute ischemic stroke.","volume":"21","author":"Kuo","year":"2021","journal-title":"BMC Neurol"},{"key":"B6","doi-asserted-by":"publisher","first-page":"e025861","DOI":"10.1161\/JAHA.122.025861","article-title":"Effect of heart rate on 1-year outcome for patients with acute ischemic stroke.","volume":"11","author":"Lee","year":"2022","journal-title":"J Am Heart Assoc"},{"key":"B7","doi-asserted-by":"publisher","first-page":"656","DOI":"10.1253\/circj.CJ-19-0946","article-title":"Resting heart rate and in-hospital mortality in acute ischemic stroke patients with and without atrial fibrillation.","volume":"84","author":"Han","year":"2020","journal-title":"Circ J"},{"key":"B8","doi-asserted-by":"publisher","first-page":"e002031","DOI":"10.1161\/JAHA.115.002031","article-title":"Increased heart rate is associated with higher mortality in patients with atrial fibrillation (AF): results from the outcomes registry for better informed treatment of af (ORBIT-AF).","volume":"4","author":"Steinberg","year":"2015","journal-title":"J Am Heart Assoc"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1501","DOI":"10.1161\/CIRCRESAHA.117.309732","article-title":"Atrial fibrillation: epidemiology, pathophysiology, and clinical outcomes.","volume":"120","author":"Staerk","year":"2017","journal-title":"Circ Res"},{"key":"B10","doi-asserted-by":"publisher","first-page":"29","DOI":"10.5543\/tkda.2024.71138","article-title":"Novel electrocardiographic marker for predicting total mortality in ischemic stroke: frontal QRS-T angle.","volume":"53","author":"Usalp","year":"2025","journal-title":"Turk Kardiyol Dern Ars"},{"key":"B11","doi-asserted-by":"publisher","first-page":"806","DOI":"10.1136\/bmj.39335.541782.AD","article-title":"Strengthening the reporting of observational studies in epidemiology (strobe) statement: guidelines for reporting observational studies.","volume":"335","author":"Von Elm","year":"2007","journal-title":"BMJ"},{"key":"B12","doi-asserted-by":"publisher","first-page":"3604","DOI":"10.1007\/s11606-023-08395-x","article-title":"A dose of reality about dose-response relationships.","volume":"38","author":"Redelmeier","year":"2023","journal-title":"J Gen Intern Med"},{"key":"B13","doi-asserted-by":"publisher","first-page":"267","DOI":"10.1186\/s12883-024-03772-3","article-title":"Assessment of the impact of resting heart rate on the risk of major adverse cardiovascular events after ischemic stroke: a retrospective observational study.","volume":"24","author":"Lin","year":"2024","journal-title":"BMC Neurol"},{"key":"B14","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1186\/s40560-021-00540-0","article-title":"Dynamic change of heart rate in the acute phase and clinical outcomes after intracerebral hemorrhage: a cohort study.","volume":"9","author":"You","year":"2021","journal-title":"J Intensive Care"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1845558\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T05:37:23Z","timestamp":1784007443000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1845558\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,14]]},"references-count":14,"alternative-id":["10.3389\/fmed.2026.1845558"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1845558","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,14]]},"article-number":"1845558"}}