Large Burden of Stroke Incidence in People with Cardiac Disease: A Linked Data Cohort Study
Keira Robinson1, Judith M Katzenellenbogen1, Timothy J Kleinig2
1School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia.
Insights
People with heart disease face a significantly higher stroke risk. Older women and younger individuals with multiple cardiac conditions, including coronary heart disease, atrial fibrillation, and valvular heart disease, require targeted interventions to reduce stroke incidence.
Area of Science:
- Cardiology
- Neurology
- Public Health
Background:
- Individuals with cardiac conditions exhibit a 2-4 times elevated risk of stroke compared to the general population.
- Understanding stroke incidence across different cardiac diseases is crucial for public health strategies.
Purpose of the Study:
- To measure and compare stroke incidence in patients with coronary heart disease (CHD), atrial fibrillation (AF), and valvular heart disease (VHD).
- To identify specific demographic groups at higher risk of stroke within cardiac patient cohorts.
Main Methods:
- Utilized a linked hospitalization/mortality dataset (1985-2017) to identify patients with CHD, AF, or VHD.
- Stratified patients into pre-existing (diagnosed before 2012) and new-onset (diagnosed 2012-2017) cardiac disease groups.
- Calculated age-specific and age-standardized stroke incidence rates (ASRs) from 2012-2017 for patients aged 20-94.
Main Results:
- A total of 175,560 individuals were analyzed; 69.9% had CHD, and 16.3% had multiple cardiac conditions.
- 5,871 first-ever strokes occurred between 2012-2017.
- Higher ASRs were observed in females than males, particularly those aged ≥75. Younger females (20-54) with multiple cardiac conditions had a 4.9-fold increased stroke incidence compared to those with single conditions.
Conclusions:
- Stroke incidence remains substantial among individuals with cardiac disease.
- Older females and younger patients with multiple cardiac conditions represent key high-risk groups.
- Targeted, evidence-based management strategies are essential to mitigate stroke burden in these vulnerable populations.
Purpose:
People with cardiac disease have 2-4 times greater risk of stroke than the general population. We measured stroke incidence in people with coronary heart disease (CHD), atrial fibrillation (AF) or valvular heart disease (VHD).
Methods:
We used a person-linked hospitalization/mortality dataset to identify all people hospitalized with CHD, AF or VHD (1985-2017), and stratified them as pre-existing (hospitalized 1985-2012 and alive at October 31, 2012) or new (first-ever cardiac hospitalization in the five-year study period, 2012-2017). We identified first-ever strokes occurring from 2012 to 2017 in patients aged 20-94 years and calculated age-specific and age-standardized rates (ASR) for each cardiac cohort.
Results:
Of the 175,560 people in the cohort, most had CHD (69.9%); 16.3% had multiple cardiac conditions. From 2012-17, 5871 first-ever strokes occurred. ASRs were greater in females than males in single and multiple condition cardiac groups, largely driven by rates in females aged ≥75 years, with stroke incidence in this age group being at least 20% greater in females than males in each cardiac subgroup. In females aged 20-54 years, stroke incidence was 4.9-fold greater in those with multiple versus single cardiac conditions. This differential declined with increasing age. Non-fatal stroke incidence was greater than fatal stroke in all age groups except in the 85-94 age group. Incidence rate ratios were up to 2-fold larger in new versus pre-existing cardiac disease.
Conclusion:
Stroke incidence in people with cardiac disease is substantial, with older females, and younger patients with multiple cardiac conditions, at elevated risk. These patients should be specifically targeted for evidence-based management to minimize the burden of stroke.
More Related Videos
Related Concept Videos
01:22Cardiac Output II: Effect of Stroke Volume on Cardiac Output
Preload
Preload refers to the initial elongation of the cardiac myocytes before contraction and is related to the volume of blood filling the heart at the end of diastole, or end-diastolic volume. The...
01:17Ischemic Heart Disease: Overview
Atherosclerosis, the primary malefactor, orchestrates this dangerous condition. It manifests as the accumulation of fatty deposits, akin to insidious plaques, within arterial walls. As time elapses, these plaques metamorphose, hardening and...
01:20Blood Studies for Cardiovascular System I: Cardiac Biomarkers
The essential diagnostic tools for detecting myocardial necrosis and monitoring individuals suspected of having acute coronary syndrome (ACS) include:
Troponins
Troponins, particularly cardiac troponins I and T, are the most precise and sensitive markers of myocardial injury. They are detectable within 4-6 hours of myocardial injury and remain...
01:26Longitudinal Studies
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:27Regulation of Stroke Volume
Preload refers to the degree of stretch on the heart before it contracts. It's analogous to the stretching of a rubber band; the more it's stretched, the more forcefully it snaps back. This concept is encapsulated in the Frank-Starling law of the...