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Heart disease contributes to high stroke mortality in Poland
A Czlonkowska1, D B Hier, T Mendel
1Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland.
Insights
Cardiac comorbidities like atrial fibrillation and congestive heart failure significantly increase stroke mortality. These conditions are linked to larger, more severe ischemic strokes, potentially explaining higher death rates in Poland.
Area of Science:
- Neurology
- Cardiology
- Public Health
Background:
- Ischemic stroke case-fatality rates in Poland are notably higher than in the United States.
- The underlying reasons for this disparity remain unclear.
Purpose of the Study:
- To investigate the contribution of cardiac comorbidities to elevated ischemic stroke case-fatality rates in Poland.
- To determine if conditions such as atrial fibrillation and congestive heart failure impact stroke severity and outcomes.
Main Methods:
- Prospective data collection on ischemic stroke patients at a regional neurological hospital in Warsaw.
- Utilized a structured data collection instrument and standard medical care.
- Assessed 30-day survival, stroke lesion characteristics via CT scans, and stroke syndrome type.
Main Results:
- A total of 252 ischemic stroke patients were analyzed.
- Patients with atrial fibrillation (AF) or congestive heart failure (CHF) exhibited significantly higher 30-day case-fatality rates (28.6% and 29.1%, respectively) compared to those without (13.9% and 12.7%).
- Ischemic lesions were larger and more widespread in patients with AF or CHF, with a higher incidence of large hemispheric syndromes.
Conclusions:
- Strokes associated with CHF or AF are generally larger and carry a higher risk of mortality.
- The high prevalence of cardiac disease in Poland may be a significant factor contributing to the elevated stroke mortality rates observed in the country.
Context:
The case-fatality rate for ischemic stroke in Poland are 3 times higher than in the United States. The reason for this difference is uncertain.
Objective:
To explore whether cardiac comorbidity contributes to high case-fatality rates for ischemic stroke in Poland.
Design:
Prospective collection of data on ischemic stroke by using a structured data collection instrument.
Setting:
A regional neurological hospital in Warsaw.
Intervention:
Standard medical care was provided to all ischemic stroke patients.
Outcome Measure:
Survival at 30 days, stroke lesion size and location by computerized tomographic scan, stroke syndrome.
Results:
252 patients with ischemic stroke were registered. Overall 30-day case-fatality rate was significantly higher in the group of patients with atrial fibrillation (AF) (28.6% v 13.9%) and congestive heart failure (CHF) (29.1% v 12.7%) than in those without these comorbidities. In patients with either AF or CHF, ischemic lesions seen on computed tomography (CT) scans were more likely to be very large (occupying more than 1 lobe) and were more likely to involve both superficial and deep structures of the brain. Large hemispheric syndromes were more likely in patients with AF (38.5% v 18.5%) and CHF (33.8% v 18.9%) than in those without these comorbidities.
Conclusions:
Strokes caused by CHF or AF tend to be larger and are more likely to lead to death. The high prevalence of cardiac disease may be one cause of high stroke mortality in Poland.
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