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Risk of Stroke in Patients With Heart Failure: A Population-Based 30-Year Cohort Study
Kasper Adelborg1, Szimonetta Szépligeti2, Jens Sundbøll2
1From the Department of Clinical Epidemiology, Aarhus University Hospital, Denmark (K.A., S.S., J.S., E.H.-P., V.W.H., A.O., L.P., H.T.S.); and Department of Health Research and Policy (Epidemiology) (V.W.H., H.T.S.) and Department of Neurology and Neurological Sciences (V.W.H.), Stanford University, CA. kade@clin.au.dk.
Insights
Heart failure significantly increases the short-term and long-term risk of all stroke types, including ischemic stroke, intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH). This highlights heart failure as a persistent risk factor for cerebrovascular events.
Area of Science:
- Cardiology
- Neurology
- Epidemiology
Background:
- The long-term stroke risk in heart failure patients is not well understood.
- Previous studies have not comprehensively assessed specific stroke subtypes (ischemic stroke, ICH, SAH) in this population.
Purpose of the Study:
- To investigate the short-term and long-term risks of ischemic stroke, intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH) in patients with heart failure.
- To compare these risks against a matched general population cohort.
Main Methods:
- Nationwide cohort study using Danish medical registries from 1980-2012.
- Inclusion of 289,353 heart failure patients and 1,446,765 matched general population controls.
- Cox regression analysis to compute age-, sex-, and comorbidity-adjusted stroke rate ratios.
Main Results:
- Heart failure patients had elevated 1- and 5-year risks for ischemic stroke (3.9%), ICH (0.5%), and SAH (0.07%).
- Short-term (30-day) stroke risk ratios were markedly increased for ischemic stroke (5.08), ICH (2.13), and SAH (3.52).
- Long-term follow-up (up to 30 years) showed persistent increased risks for all stroke subtypes in heart failure patients compared to the general population.
Conclusions:
- Heart failure is associated with significantly increased short-term and long-term risks for all major stroke subtypes.
- Heart failure acts as a potent and persistent risk factor for ischemic stroke, ICH, and SAH.
- These findings underscore the need for proactive stroke prevention strategies in heart failure management.
Background And Purpose:
The long-term risk of specific stroke subtypes among heart failure patients is largely unknown. We examined short-term and long-term risk of ischemic stroke, intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH) in heart failure patients and in a general population comparison cohort.
Methods:
In this nationwide cohort study (1980-2012), we used Danish population-based medical registries to identify and follow (1) all patients hospitalized for the first time with heart failure and (2) a birth year-, sex-, and calendar year-matched general population comparison cohort. Age-, sex-, and comorbidity-adjusted stroke rate ratios were computed based on Cox regression analysis.
Results:
We included 289 353 patients with heart failure and 1 446 765 individuals from the general population in the analysis. One- and 5-year risks among heart failure patients were 1.4% and 3.9% for ischemic stroke, 0.2% and 0.5% for ICH, and 0.03% and 0.07% for SAH. The 30-day adjusted stroke rate ratio was increased markedly for ischemic stroke (5.08; 95% confidence interval, 4.58-5.63] and was also elevated for ICH (2.13; 95% confidence interval, 1.53-2.97) and SAH (3.52; 95% confidence interval, 1.54-8.08). Between 31 days and 30 years, risk of all stroke subtypes remained positively associated with heart failure (1.5- to 2.1-fold for ischemic stroke, 1.4- to 1.8-fold for ICH, and 1.1- to 1.7-fold for SAH) in comparison with the general population cohort.
Conclusions:
Heart failure was associated with increased short-term and long-term risk of all stroke subtypes, suggesting that heart failure is a potent and persistent risk factor for ischemic stroke, ICH, and SAH.