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Risk of stroke in patients with congenital heart disease: a systematic review and meta-analysis
Ramez M Odat1, Muhammad Idrees2, Hritvik Jain3
1Faculty of medicine, Jordan University of Science and Technology, Irbid, Jordan.
Insights
Patients with congenital heart disease (CHD) face a significantly higher risk of stroke. This meta-analysis confirms increased stroke risk, particularly ischemic and hemorrhagic types, in CHD populations.
Area of Science:
- Cardiology
- Neurology
- Public Health
Background:
- Patients with congenital heart disease (CHD) have elevated risks of ischemic and hemorrhagic stroke.
- Factors contributing to stroke risk in CHD include arrhythmias, shunts, and cardiovascular complications.
- Current guidelines lack clarity in identifying high-risk CHD patients for stroke prevention.
Purpose of the Study:
- To evaluate the overall risk of stroke in patients diagnosed with congenital heart disease.
- To synthesize existing evidence on stroke incidence among individuals with CHD.
Main Methods:
- A systematic literature search was conducted across major databases (PubMed, Scopus, Cochrane, Embase).
- A random-effects model meta-analysis pooled hazard ratios (HR) and 95% confidence intervals (CI) from 11 studies involving over 5.4 million participants.
- Subgroup analyses examined variations in stroke risk by age, stroke type, study design, and geographic region.
Main Results:
- Patients with CHD exhibited a significantly higher risk of stroke (Pooled HR: 3.25; 95% CI: 2.25, 4.68).
- Elevated risks were observed for both ischemic stroke (Pooled HR: 4.45; 95% CI: 2.24, 8.85) and hemorrhagic stroke (Pooled HR: 4.70; 95% CI: 1.70, 12.96).
- Stroke risk was notably higher in European regions and among adult populations compared to pediatric groups.
Conclusions:
- This meta-analysis confirms a substantially increased risk of stroke in patients with congenital heart disease.
- Findings highlight regional disparities and age-related differences in stroke risk within the CHD population.
- Further research is needed to address data and regional limitations, informing clinical strategies for stroke risk management in CHD.
Background:
Patients with congenital heart disease (CHD) are more likely to experience ischemic and hemorrhagic stroke due to factors such as arrhythmias, residual shunts and related cardiovascular complications. However, guidelines for identifying CHD patients at the highest risk of stroke remain unclear. In this study, we aimed to evaluate the risk of developing stroke in patients with CHD.
Methods:
A systematic literature search was performed on PubMed, Scopus, Cochrane, and Embase databases to retrieve studies that evaluated stroke risk in patients with CHD. Random effects model was used to pool the hazard ratios (HR) with 95% confidence intervals (CI). Subgroup analysis was conducted on age, type of stroke, type of study and region. Publication bias was assessed by Egger's regression test. Statistical significance was set at p < 0.05. All the analysis was performed using R studio V4.3.1.
Results:
Eleven studies (5,490,412 participants) were included in this systematic review and meta-analysis. Patients with CHD were at a higher risk of stroke [Pooled HR: 3.25; 95% CI: 2.25, 4.68; p < 0.01; I2: 100%] than the control group. In subgroup analysis, patients with CHD were at a higher risk of ischemic stroke [Pooled HR: 4.45; 95% CI: 2.24, 8.85; p < 0.01; I2: 100%] and hemorrhagic stroke [Pooled HR: 4.70; 95% CI: 1.70, 12.96; p < 0.01; I2: 99%] than the control group.
Conclusion:
Our meta-analysis indicates a significantly increased stroke risk in patients with CHD. Subgroup analyses showed higher stroke risk in European regions compared to Asia and USA, and among adults compared to pediatric populations. Future studies should focus on addressing regional and data limitations to better inform clinical strategies for managing stroke risk in CHD patients.
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