Abstract
Background and Purpose—
We aimed to determine individual and combined effects of atrial fibrillation (AF) and heart failure (HF) on acute ischemic stroke outcomes: in-hospital mortality, length-of-stay, and poststroke disability; long-term mortality and stroke recurrence.
Methods—
Prospective cohort study of patients with acute ischemic stroke admitted to a UK center with a catchment population of ≈900 000 between 2004 and 2016. Exposure groups were patients with neither AF nor HF (reference group), those with AF but without HF, those with HF but without AF, and those with AF+HF. Logistic and Cox regressions were used to model in-hospital and long-term outcomes, respectively.
Results—
A total of 10 816 patients with a mean age±SD =77.9±12.1 years, 48% male were included. Only 30 (4.9%) of the patients with HF but not AF were anticoagulated at discharge. Both AF (odds ratio, 1.24 [95% CI, 1.07–1.43]), HF (odds ratio, 1.40 [1.10–1.79]), and their combination (odds ratio, 2.23 [1.83–2.72]) were associated with increased odds of in-hospital mortality. All 3 exposure groups were associated with increased length-of-stay, while only AF predicted increased disability (1.36 [1.12–1.64]). Patients were followed for a median of 5.5 and 3.7 years for mortality and recurrence, respectively. Long-term mortality was associated with AF (hazard ratio, 1.45 [95% CI, 1.33–1.59]), HF (2.07 [1.83–2.36]), and their combination (2.20 [1.96–2.46]). Recurrent stroke was associated with AF 1.50 (1.26–1.78), HF (1.33 [1.01–1.75]), and AF with HF (1.62 [1.28–2.07]).
Conclusions—
The AF-associated excess risk of stroke recurrence was independent of comorbid HF. HF without AF was also associated with a significant risk of recurrence. Anticoagulation for secondary stroke prevention in patients with HF without AF may require further evaluation in a clinical trial setting.
We aimed to determine individual and combined effects of atrial fibrillation (AF) and heart failure (HF) on acute ischemic stroke outcomes: in-hospital mortality, length-of-stay, and poststroke disability; long-term mortality and stroke recurrence.
Methods—
Prospective cohort study of patients with acute ischemic stroke admitted to a UK center with a catchment population of ≈900 000 between 2004 and 2016. Exposure groups were patients with neither AF nor HF (reference group), those with AF but without HF, those with HF but without AF, and those with AF+HF. Logistic and Cox regressions were used to model in-hospital and long-term outcomes, respectively.
Results—
A total of 10 816 patients with a mean age±SD =77.9±12.1 years, 48% male were included. Only 30 (4.9%) of the patients with HF but not AF were anticoagulated at discharge. Both AF (odds ratio, 1.24 [95% CI, 1.07–1.43]), HF (odds ratio, 1.40 [1.10–1.79]), and their combination (odds ratio, 2.23 [1.83–2.72]) were associated with increased odds of in-hospital mortality. All 3 exposure groups were associated with increased length-of-stay, while only AF predicted increased disability (1.36 [1.12–1.64]). Patients were followed for a median of 5.5 and 3.7 years for mortality and recurrence, respectively. Long-term mortality was associated with AF (hazard ratio, 1.45 [95% CI, 1.33–1.59]), HF (2.07 [1.83–2.36]), and their combination (2.20 [1.96–2.46]). Recurrent stroke was associated with AF 1.50 (1.26–1.78), HF (1.33 [1.01–1.75]), and AF with HF (1.62 [1.28–2.07]).
Conclusions—
The AF-associated excess risk of stroke recurrence was independent of comorbid HF. HF without AF was also associated with a significant risk of recurrence. Anticoagulation for secondary stroke prevention in patients with HF without AF may require further evaluation in a clinical trial setting.
Original language | English |
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Pages (from-to) | 1838-1845 |
Number of pages | 8 |
Journal | Stroke |
Volume | 50 |
Issue number | 7 |
Early online date | 3 Jun 2019 |
DOIs | |
Publication status | Published - Jul 2019 |
Bibliographical note
We thank the data team of the Norfolk and Norwich University Hospital Stroke Services, Prof Kristian Bowles (one of the co-Principal Investigators of the stroke register) and our lay steering committee members and independent chair Prof Alastair Forbes (Chief of Research & Innovation, Norfolk and Norwich University Hospital).SOURCES OF FUNDING
TAP received the Medical Research Scotland 2018 Vacation Scholarship [grant number Vac-1211-2018] to perform the research. The Norfolk and Norwich Stroke Register is maintained by the Norfolk and Norwich University Hospital Stroke Services.
Keywords
- atrial fibrillation
- heart failure
- cerebrovascular disease
- stroke
- mortality
- recurrence
- POPULATION
- DEMENTIA
- FOLLOW-UP
- CLINICAL-FEATURES
- ASPIRIN
- population
- TRIAL
- RISK-FACTOR
- WARFARIN
- PREDICTORS
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David McLernon
- School of Medicine, Medical Sciences & Nutrition, Applied Health Sciences - Senior Research Fellow
- School of Medicine, Medical Sciences & Nutrition, Medical Statistics
Person: Academic Related - Research
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Phyo Myint, Clinical Chair in Medicine of Old Age
- School of Medicine, Medical Sciences & Nutrition, Aberdeen Cardiovascular and Diabetes Centre
- School of Medicine, Medical Sciences & Nutrition, Applied Health Sciences - Chair in Old Age Medicine (Clinical)
- Institute of Applied Health Sciences
Person: Clinical Academic