Background:
The effects of circadian rhythm on stroke can include increases in morning heart rate, blood pressure, catecholamines, platelet aggregation, and hypercoagulability and might correlate with higher numbers of morning strokes. We assessed time of day and frequency of stroke code activation for a potential role of circadian rhythm in stroke risk.
Methods:
A retrospective analysis of prospectively collected data from an IRB approved stroke registry, from July 2004 to July 2020, was performed. Codes were included where stroke codes were activated with last known well (LKW) <6 hours to limit the effect of wake-up strokes and equalize changing practice patterns over time. Subjects were divided into four epochs based on code activation: Night (00:00-05:59), Morning (06:00-11:59), Afternoon (12:00-17:59), and Evening (18:00-23:59). Confirmed diagnosis of stroke, baseline blood pressure (SBP & DBP), heart rate (HR), and PTT were compared. Chi squared was used to compare categorical data and t test for continuous.
Results:
A total of 5,366 subjects were identified. Stroke code activations differed across epochs (Night n=312, 5.81%; Morning n=1439, 26.82%; Afternoon n=2207, 41.13%; Evening n=1408, 26.24%: p<0.0001). In the subset analysis of true strokes, activations also differed across epochs (Night n=125, 5.26%; Morning n= 831, 34.95%; Afternoon n=934, 39.28%; Evening n=488, 20.52%: p<0.0001). Overall, SBP was different with Evening highest and Morning lowest (x 151.6, x 148.2;p=0.01). Overall DBP showed Night highest and Afternoon lowest (x 83.9, x 81;p=0.002). Heart rate showed Night highest and Morning lowest (x 84.9, x 81.6;p=0.002).
Conclusions:
This study found that most stroke code activations occur in Afternoons at this CSC. This may be due to patient level characteristics, bystander availability, or other factors. Future studies should assess multi-center data and include other circadian rhythm biomarkers.