Background: Intracerebral hemorrhage (ICH) is a leading cause of disability and mortality, accounting for 20-30% of acute cerebrovascular events. Resting heart rate (RHR) is an important vital sign linked to prognosis, particularly in cardiovascular diseases. This study investigates the association between RHR and all-cause mortality (ACM) in intensive care unit (ICU) patients with ICH. Methods: Data were extracted from the MIMIC-IV database. Patients were divided into quartiles (Q1?Q4) based on RHR. ACM at 30 days, 90 days, and one year was assessed. Kaplan-Meier curves, multivariate Cox regression, and restricted cubic splines were used to analyze the relationship between RHR and ACM, with receiver operating characteristic curves evaluating the predictive value of RHR >90.3 beats per minute (bpm). Results: A total of 1,918 patients were included. Survival curves showed significantly higher mortality in higher RHR quartiles (Q3 and Q4) compared to Q1 and Q2. Multivariate Cox regression confirmed that RHR above the second quartile (RHR=78.5 bpm) was linked to higher mortality. Restricted cubic splines revealed a nonlinear relationship between elevated RHR and increased mortality. Conclusions: A resting heart rate below 90.3 bpm may serve as an independent protective factor against all-cause mortality in patients with intracerebral hemorrhage in the intensive care unit. In contrast, an elevated resting heart rate exceeding 90.3 bpm may be independently associated with an increased risk of all-cause mortality in this population.

The authors have declared no competing interest.

This research was funded by grants from the National Natural Science Foundation of China (No. 82070541, 81600625, both to ML; 82271406, 81771332, 81571184, all to CZ); the Natural Science Foundation of Shanghai (22ZR1451200, to CZ), the Health Industry Clinical Research Project of Shanghai Municipal Health Commission (20204125, to ML; 201840110, to SX); the Key Disciplines Group Construction Project of Shanghai Pudong New Area Health Commission (PWZxq2022-10, to CZ); the Medical Discipline Construction Project of Pudong Health Committee of Shanghai (PWYgy2021-07, to CZ); the Li Jieshou Intestinal Barrier Research Foundation (LJS-201901A, to ML); the Japan-China Sasagawa Medical Fellowship (to ML).

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The study adhered to the ethical principles outlined in the Helsinki Declaration. The utilization of the MIMIC-IV database has been approved by the review committees of the Massachusetts Institute of Technology and Beth Israel Deaconess Medical Center, and the requirement for additional ethical approval and informed consent were waived as the data is publicly accessible via the MIMIC-IV database.

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The datasets used and/or analyzed during the current study are available from corresponding author on reasonable request.