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Acute Decompensated Heart Failure Complicated by Ischemic Stroke and Its Association With Hemoglobin Levels
Yusuke Yamazaki1, Yasuyuki Shiraishi1, Shun Kohsaka1
1Department of Cardiology, Keio University School of Medicine Tokyo Japan.
Circulation Reports
|May 11, 2026
Summary
Patients hospitalized for acute decompensated heart failure (ADHF) face a higher risk of ischemic stroke (IS), particularly within 30 days. Non-anemia is linked to increased early-phase IS risk, aiding in risk stratification.
Area of Science:
- Cardiology
- Neurology
- Hematology
Background:
- Ischemic stroke (IS) is an under-recognized complication of acute decompensated heart failure (ADHF).
- Understanding the relationship between hemoglobin levels and IS risk in ADHF patients is crucial for risk stratification and management.
Purpose of the Study:
- To assess the incidence, subtypes, and phase-specific association between hemoglobin levels and ischemic stroke risk in patients hospitalized for ADHF.
Main Methods:
- A prospective multicenter cohort study (West Tokyo Heart Failure Registry-2) included 5,106 patients hospitalized for ADHF.
- Ischemic stroke incidence and subtypes were evaluated in early (≤30 days) and late (>30 days) phases relative to hemoglobin levels (anemic/non-anemic).
- Multivariable Fine-Gray models were used to analyze the association between non-anemia and IS risk, accounting for competing risk of death.
Main Results:
- 115 patients (2.3%) developed IS during a median 13-month follow-up, with incidence peaking in the early phase (median onset 7 days).
- Cardioembolic stroke predominated (61.7%) in both phases.
- Non-anemia was independently associated with increased early-phase IS risk (SHR 2.04; P=0.03) but not late-phase IS.
Conclusions:
- Ischemic stroke in ADHF patients frequently occurs within 30 days of hospitalization and is predominantly cardioembolic.
- Non-anemia is a significant risk factor for early-phase IS in ADHF patients.
- Hemoglobin status, specifically non-anemia, may serve as a valuable marker for early IS risk stratification in ADHF.
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