Rheumatic Mitral Valve Disease Is Associated With Worse Outcomes in Stroke

A Thailand National Database Study

Adrian D Wood, Gurdeep S Mannu, Allan B Clark, Somsak Tiamkao, Kannikar Kongbunkiat, Joao H Bettencourt-Silva, Kittisak Sawanyawisuth, Narongrit Kasemsap, Raphae S Barlas, Mamas A Mamas, Phyo K Myint

Research output: Contribution to journalArticle

3 Citations (Scopus)
3 Downloads (Pure)

Abstract

Background and Purpose—Rheumatic valvular heart disease is associated with the increased risk of cerebrovascular events, although there are limited data on the prognosis of patients with rheumatic mitral valve disease (RMVD) after stroke.

Methods—We examined the association between RMVD and both serious and common cardiovascular and noncardiovascular (respiratory and infective) complications in a cohort of hospitalized stroke patients based in Thailand. Factors associated with in-hospital mortality were also explored. Data were obtained from a National Insurance Database. All hospitalized strokes between October 1, 2004, and January 31, 2013, were included in the current study. Characteristics and outcomes were compared for RMVD and non-RMVD patients. Logistic regression, propensity score matching, and multivariate models were used to assess study outcomes.

Results—In total, 594 681 patients (mean [SD] age=64 [14.5] years) with a diagnosis of stroke (ischemic=306 154; hemorrhagic=195 392; undetermined=93 135) were included in this study, of whom 5461 had RMVD. Results from primary analyses showed that after ischemic stroke, and controlling for potential confounding covariates, RMVD was associated (P<0.001) with increased odds for cardiac arrest (odds ratio [95% confidence interval]=2.13 [1.68–2.70]), shock (2.13 [1.64–2.77]), arrhythmias (1.70 [1.21–2.39]), respiratory failure (2.09 [1.87–2.33]), pneumonia (2.00 [1.81–2.20]), and sepsis (1.39 [1.19–1.63]). In hemorrhagic stroke patients, RMVD was associated with increased odds (fully adjusted model) for respiratory failure (1.26 [1.01–1.57]), and in patients with undetermined stroke, RMVD was associated with increased odds (fully adjusted analyses) for shock (3.00 [1.46–6.14]), respiratory failure (2.70 [1.91–3.79]), and pneumonia (2.42 [1.88–3.11]).

Conclusions—RMVD is associated with the development of cardiac arrest, shock, arrhythmias, respiratory failure, pneumonia, and sepsis after acute stroke.

Original languageEnglish
Pages (from-to)2695-2701
Number of pages7
JournalStroke
Volume47
Issue number11
Early online date4 Oct 2016
DOIs
Publication statusPublished - Nov 2016

Fingerprint

Thailand
Mitral Valve
Stroke
Databases
Respiratory Insufficiency
Shock
Pneumonia
Heart Arrest
Cardiac Arrhythmias
Sepsis
Propensity Score
Heart Valve Diseases
Hospital Mortality
Rheumatic Diseases
Insurance
Logistic Models
Odds Ratio
Outcome Assessment (Health Care)
Confidence Intervals

Keywords

  • complications
  • epidemiology
  • mortality
  • rheumatic heart disease
  • stroke

Cite this

Wood, A. D., Mannu, G. S., Clark, A. B., Tiamkao, S., Kongbunkiat, K., Bettencourt-Silva, J. H., ... Myint, P. K. (2016). Rheumatic Mitral Valve Disease Is Associated With Worse Outcomes in Stroke: A Thailand National Database Study. Stroke, 47(11), 2695-2701. https://doi.org/10.1161/STROKEAHA.116.014512

Rheumatic Mitral Valve Disease Is Associated With Worse Outcomes in Stroke : A Thailand National Database Study. / Wood, Adrian D; Mannu, Gurdeep S; Clark, Allan B; Tiamkao, Somsak ; Kongbunkiat, Kannikar; Bettencourt-Silva, Joao H; Sawanyawisuth, Kittisak ; Kasemsap, Narongrit; Barlas, Raphae S; Mamas, Mamas A; Myint, Phyo K.

In: Stroke, Vol. 47, No. 11, 11.2016, p. 2695-2701.

Research output: Contribution to journalArticle

Wood, AD, Mannu, GS, Clark, AB, Tiamkao, S, Kongbunkiat, K, Bettencourt-Silva, JH, Sawanyawisuth, K, Kasemsap, N, Barlas, RS, Mamas, MA & Myint, PK 2016, 'Rheumatic Mitral Valve Disease Is Associated With Worse Outcomes in Stroke: A Thailand National Database Study', Stroke, vol. 47, no. 11, pp. 2695-2701. https://doi.org/10.1161/STROKEAHA.116.014512
Wood AD, Mannu GS, Clark AB, Tiamkao S, Kongbunkiat K, Bettencourt-Silva JH et al. Rheumatic Mitral Valve Disease Is Associated With Worse Outcomes in Stroke: A Thailand National Database Study. Stroke. 2016 Nov;47(11):2695-2701. https://doi.org/10.1161/STROKEAHA.116.014512
Wood, Adrian D ; Mannu, Gurdeep S ; Clark, Allan B ; Tiamkao, Somsak ; Kongbunkiat, Kannikar ; Bettencourt-Silva, Joao H ; Sawanyawisuth, Kittisak ; Kasemsap, Narongrit ; Barlas, Raphae S ; Mamas, Mamas A ; Myint, Phyo K. / Rheumatic Mitral Valve Disease Is Associated With Worse Outcomes in Stroke : A Thailand National Database Study. In: Stroke. 2016 ; Vol. 47, No. 11. pp. 2695-2701.
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abstract = "Background and Purpose—Rheumatic valvular heart disease is associated with the increased risk of cerebrovascular events, although there are limited data on the prognosis of patients with rheumatic mitral valve disease (RMVD) after stroke.Methods—We examined the association between RMVD and both serious and common cardiovascular and noncardiovascular (respiratory and infective) complications in a cohort of hospitalized stroke patients based in Thailand. Factors associated with in-hospital mortality were also explored. Data were obtained from a National Insurance Database. All hospitalized strokes between October 1, 2004, and January 31, 2013, were included in the current study. Characteristics and outcomes were compared for RMVD and non-RMVD patients. Logistic regression, propensity score matching, and multivariate models were used to assess study outcomes.Results—In total, 594 681 patients (mean [SD] age=64 [14.5] years) with a diagnosis of stroke (ischemic=306 154; hemorrhagic=195 392; undetermined=93 135) were included in this study, of whom 5461 had RMVD. Results from primary analyses showed that after ischemic stroke, and controlling for potential confounding covariates, RMVD was associated (P<0.001) with increased odds for cardiac arrest (odds ratio [95{\%} confidence interval]=2.13 [1.68–2.70]), shock (2.13 [1.64–2.77]), arrhythmias (1.70 [1.21–2.39]), respiratory failure (2.09 [1.87–2.33]), pneumonia (2.00 [1.81–2.20]), and sepsis (1.39 [1.19–1.63]). In hemorrhagic stroke patients, RMVD was associated with increased odds (fully adjusted model) for respiratory failure (1.26 [1.01–1.57]), and in patients with undetermined stroke, RMVD was associated with increased odds (fully adjusted analyses) for shock (3.00 [1.46–6.14]), respiratory failure (2.70 [1.91–3.79]), and pneumonia (2.42 [1.88–3.11]).Conclusions—RMVD is associated with the development of cardiac arrest, shock, arrhythmias, respiratory failure, pneumonia, and sepsis after acute stroke.",
keywords = "complications, epidemiology, mortality, rheumatic heart disease, stroke",
author = "Wood, {Adrian D} and Mannu, {Gurdeep S} and Clark, {Allan B} and Somsak Tiamkao and Kannikar Kongbunkiat and Bettencourt-Silva, {Joao H} and Kittisak Sawanyawisuth and Narongrit Kasemsap and Barlas, {Raphae S} and Mamas, {Mamas A} and Myint, {Phyo K}",
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TY - JOUR

T1 - Rheumatic Mitral Valve Disease Is Associated With Worse Outcomes in Stroke

T2 - A Thailand National Database Study

AU - Wood, Adrian D

AU - Mannu, Gurdeep S

AU - Clark, Allan B

AU - Tiamkao, Somsak

AU - Kongbunkiat, Kannikar

AU - Bettencourt-Silva, Joao H

AU - Sawanyawisuth, Kittisak

AU - Kasemsap, Narongrit

AU - Barlas, Raphae S

AU - Mamas, Mamas A

AU - Myint, Phyo K

PY - 2016/11

Y1 - 2016/11

N2 - Background and Purpose—Rheumatic valvular heart disease is associated with the increased risk of cerebrovascular events, although there are limited data on the prognosis of patients with rheumatic mitral valve disease (RMVD) after stroke.Methods—We examined the association between RMVD and both serious and common cardiovascular and noncardiovascular (respiratory and infective) complications in a cohort of hospitalized stroke patients based in Thailand. Factors associated with in-hospital mortality were also explored. Data were obtained from a National Insurance Database. All hospitalized strokes between October 1, 2004, and January 31, 2013, were included in the current study. Characteristics and outcomes were compared for RMVD and non-RMVD patients. Logistic regression, propensity score matching, and multivariate models were used to assess study outcomes.Results—In total, 594 681 patients (mean [SD] age=64 [14.5] years) with a diagnosis of stroke (ischemic=306 154; hemorrhagic=195 392; undetermined=93 135) were included in this study, of whom 5461 had RMVD. Results from primary analyses showed that after ischemic stroke, and controlling for potential confounding covariates, RMVD was associated (P<0.001) with increased odds for cardiac arrest (odds ratio [95% confidence interval]=2.13 [1.68–2.70]), shock (2.13 [1.64–2.77]), arrhythmias (1.70 [1.21–2.39]), respiratory failure (2.09 [1.87–2.33]), pneumonia (2.00 [1.81–2.20]), and sepsis (1.39 [1.19–1.63]). In hemorrhagic stroke patients, RMVD was associated with increased odds (fully adjusted model) for respiratory failure (1.26 [1.01–1.57]), and in patients with undetermined stroke, RMVD was associated with increased odds (fully adjusted analyses) for shock (3.00 [1.46–6.14]), respiratory failure (2.70 [1.91–3.79]), and pneumonia (2.42 [1.88–3.11]).Conclusions—RMVD is associated with the development of cardiac arrest, shock, arrhythmias, respiratory failure, pneumonia, and sepsis after acute stroke.

AB - Background and Purpose—Rheumatic valvular heart disease is associated with the increased risk of cerebrovascular events, although there are limited data on the prognosis of patients with rheumatic mitral valve disease (RMVD) after stroke.Methods—We examined the association between RMVD and both serious and common cardiovascular and noncardiovascular (respiratory and infective) complications in a cohort of hospitalized stroke patients based in Thailand. Factors associated with in-hospital mortality were also explored. Data were obtained from a National Insurance Database. All hospitalized strokes between October 1, 2004, and January 31, 2013, were included in the current study. Characteristics and outcomes were compared for RMVD and non-RMVD patients. Logistic regression, propensity score matching, and multivariate models were used to assess study outcomes.Results—In total, 594 681 patients (mean [SD] age=64 [14.5] years) with a diagnosis of stroke (ischemic=306 154; hemorrhagic=195 392; undetermined=93 135) were included in this study, of whom 5461 had RMVD. Results from primary analyses showed that after ischemic stroke, and controlling for potential confounding covariates, RMVD was associated (P<0.001) with increased odds for cardiac arrest (odds ratio [95% confidence interval]=2.13 [1.68–2.70]), shock (2.13 [1.64–2.77]), arrhythmias (1.70 [1.21–2.39]), respiratory failure (2.09 [1.87–2.33]), pneumonia (2.00 [1.81–2.20]), and sepsis (1.39 [1.19–1.63]). In hemorrhagic stroke patients, RMVD was associated with increased odds (fully adjusted model) for respiratory failure (1.26 [1.01–1.57]), and in patients with undetermined stroke, RMVD was associated with increased odds (fully adjusted analyses) for shock (3.00 [1.46–6.14]), respiratory failure (2.70 [1.91–3.79]), and pneumonia (2.42 [1.88–3.11]).Conclusions—RMVD is associated with the development of cardiac arrest, shock, arrhythmias, respiratory failure, pneumonia, and sepsis after acute stroke.

KW - complications

KW - epidemiology

KW - mortality

KW - rheumatic heart disease

KW - stroke

U2 - 10.1161/STROKEAHA.116.014512

DO - 10.1161/STROKEAHA.116.014512

M3 - Article

VL - 47

SP - 2695

EP - 2701

JO - Stroke

JF - Stroke

SN - 0039-2499

IS - 11

ER -