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Impact of Prior Ischemic Stroke on Outcomes in Patients With Heart Failure - A Propensity-Matched Study
Yu Wang1, Meng-Xi Yang1, Qiang Tu2,3
1Department of Cardiology, China-Japan Friendship Hospital.
Insights
Prior ischemic stroke significantly worsens outcomes for heart failure (HF) patients. This condition increases the risk of death and hospital readmission, persisting long-term.
Area of Science:
- Cardiology
- Neurology
- Clinical Research
Background:
- Heart failure (HF) prognosis is complex, with uncertainty regarding the independent impact of ischemic stroke.
- Older age and comorbidities are known risk factors, but the specific contribution of prior ischemic stroke requires clarification.
Purpose of the Study:
- To investigate the intrinsic association between prior ischemic stroke and adverse outcomes in heart failure patients.
- To determine if ischemic stroke independently predicts mortality and hospital readmissions in HF.
Main Methods:
- A propensity-matched cohort study was conducted using data from 1,351 hospitalized HF patients.
- 388 patients with prior ischemic stroke were matched with 379 controls based on 32 baseline characteristics.
- Outcomes including all-cause death, all-cause readmission, and HF readmission were assessed at 30 days, 6 months, and 1 year.
Main Results:
- Prior ischemic stroke was associated with significantly higher risks of combined death or readmission (HR 1.91) at 30 days.
- Increased risks were observed for all-cause death (HR 2.08), all-cause readmission (HR 2.67), and HF readmission (HR 2.11) at 30 days.
- These adverse associations persisted at 6 months and 1 year follow-up.
Conclusions:
- Prior ischemic stroke is a potent and independent predictor of adverse outcomes in heart failure patients.
- The increased risk of death and readmission associated with ischemic stroke is persistent over time.
- Clinical management of HF patients should consider the significant impact of prior ischemic stroke.
Background:
Whether ischemic stroke per se, rather than older age or additional comorbidities, accounts for the adverse prognosis of heart failure (HF) is uncertain. The present study examineed the intrinsic association of ischemic stroke with outcomes in a propensity-matched cohort.
Methods And Results:
Of 1,351 patients hospitalized with HF, 388 (28.7%) had prior ischemic stroke. Using propensity score for prior ischemic stroke, estimated for each patient, a matched cohort of 379 pairs of HF patients with and without prior ischemic stroke, balanced on 32 baseline characteristics was assembled. At 30 days, prior ischemic stroke was associated with significantly higher risks of the combined endpoint of all-cause death or readmission (hazard ratio [HR]: 1.91; 95% confidence interval [CI]: 1.38 to 2.65; P<0.001), all-cause death (HR: 2.08; 95% CI: 1.28 to 3.38; P=0.003), all-cause readmission (HR: 2.67; 95% CI: 1.78 to 4.01; P<0.001), and HF readmission (HR: 2.11; 95% CI: 1.19 to 3.72; P=0.010). Prior ischemic stroke was associated with a significantly higher risk of all 4 outcomes at both 6 months and 1 year.
Conclusions:
Prior ischemic stroke was a potent and persistent risk predictor of death and readmission among patients with HF after accounting for clinical characteristics.
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