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Epidemiology of stroke in chronic heart failure patients with normal sinus rhythm: findings from the DIG stroke

Marjan Mujib1, Grigorios Giamouzis, Syed Abbas Agha

  • 1University of Alabama at Birmingham, 1530 3rd Avenue South, CH-19, Ste-219, Birmingham, AL 35294-2041, USA.

International Journal of Cardiology
|May 15, 2009
PubMed

Insights

Stroke risk factors in heart failure patients include older age, hypertension, diabetes, and cardiomegaly. Nonwhite race showed a complex association, decreasing stroke risk but increasing severity and mortality post-stroke.

Area of Science:

  • Cardiology
  • Neurology
  • Epidemiology

Background:

  • Limited data exists on stroke epidemiology in heart failure (HF) patients with normal sinus rhythm (NSR) on angiotensin-converting enzyme (ACE) inhibitors.
  • The Digitalis Investigation Group (DIG) trial provided a unique cohort (N=7788) of HF patients in NSR, nearly all on ACE inhibitors, for stroke research.

Purpose of the Study:

  • To investigate the epidemiology of stroke in chronic systolic and diastolic heart failure patients in normal sinus rhythm receiving ACE inhibitors.
  • To identify predictors of stroke incidence and outcomes in this specific patient population.

Main Methods:

  • Analysis of a stroke sub-study from the Digitalis Investigation Group (DIG) trial (N=7788).
  • Logistic regression models were used to identify predictors of incident stroke.
  • Further analysis determined predictors of neurological deficit (≥24 hours) and all-cause mortality among stroke patients.

Main Results:

  • Independent predictors of stroke included older age (≥65 years), hypertension, diabetes mellitus, and cardiomegaly.
  • Nonwhite race was associated with a decreased risk of stroke (AOR, 0.65).
  • However, among stroke patients, nonwhite race was linked to increased odds of severe neurological deficits (≥24 hours) and higher mortality (AOR, 3.28).

Conclusions:

  • Older age, hypertension, diabetes, and cardiomegaly are significant risk factors for stroke in HF patients on ACE inhibitors.
  • The relationship between race and stroke is complex: nonwhite race may reduce stroke incidence but worsen stroke outcomes and mortality.
  • These findings highlight the need for targeted stroke prevention and management strategies in diverse HF populations.
Abstract

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