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Published on: June 10, 2025
Characterization of incident heart failure after ischaemic stroke/transient ischaemic attack: a UK Biobank study
Rahul G Muthalaly1, Nitesh Nerlekar1, Sean Tan1
1Victorian Heart Institute, Monash University, 631 Blackburn Road, Clayton, VIC 3168, Australia.
Insights
Heart failure (HF) is common in stroke survivors, significantly increasing mortality risk. Early identification and preventive therapies are crucial for this high-risk population.
Area of Science:
- Cardiovascular Medicine
- Neurology
- Epidemiology
Background:
- Ischaemic stroke and transient ischaemic attack (TIA) survivors face increased risks for subsequent cardiovascular events.
- Heart failure (HF) is a significant concern, but its incidence and impact on mortality in this specific population require further definition.
Purpose of the Study:
- To determine the incidence of new-onset heart failure (HF) in individuals who have experienced an ischaemic stroke or TIA.
- To investigate the association between incident HF and all-cause mortality in stroke survivors.
- To characterize cardiac magnetic resonance (CMR) findings in stroke survivors with and without HF.
Main Methods:
- A prospective cohort study utilizing the UK Biobank (UKBB) cohort, including 405,406 individuals aged 40-69.
- Exclusion of participants with prior HF, followed by stratification based on ischaemic stroke/TIA history.
- Primary outcome: incident HF via hospital admission codes; secondary outcomes: all-cause mortality, myocardial infarction, and CMR findings.
Main Results:
- Over 13.7 years, 15,565 individuals developed incident HF. Stroke survivors showed a significantly higher risk of HF hospitalization (adjusted HR 1.4).
- The risk of HF hospitalization (12.6%) exceeded that of myocardial infarction (5.4%) in stroke survivors.
- Stroke survivors with HF exhibited lower left ventricular ejection fraction (LVEF) and higher left ventricular (LV) mass. Incident HF was linked to an 80% increased mortality risk (HR 1.8).
Conclusions:
- Incident HF is a prevalent complication in stroke survivors, strongly associated with increased mortality.
- The risk of HF is heterogeneous and influenced by various underlying risk factors.
- Exploratory findings suggest a potential lower ejection fraction phenotype in stroke survivors with HF, warranting further investigation and preventive therapy trials.
Introduction:
To define incident heart failure (HF) risk in ischaemic stroke/transient ischaemic attack (TIA) survivors. The secondary aims were to define the association of HF with all-cause mortality in stroke survivors and to describe their cardiac magnetic resonance (CMR) findings.
Methods:
This was a prospective cohort study using the UK Biobank (UKBB) cohort of individuals aged 40 to 69 years old. We excluded individuals with prior HF and stratified them by history of ischaemic stroke/TIA. The main outcome was incident HF as defined by hospital admissions coded for heart failure. Secondary outcomes were all-cause mortality, myocardial infarction, and CMR findings.
Results:
We included 405 406 individuals (age 56.5 years, 45.6% males). Over 13.7 years, 15 565 individuals experienced incident HF. Stroke survivors had an overall HR of 3.6 [95% confidence interval (CI) 3.3-3.8, P < .0001] for HF hospitalization and an adjusted HR of 1.4 (95% CI 1.3-1.5, P < .0001). The risk of HF hospitalization was greater than the risk of myocardial infarction (12.6% vs 5.4%). Stroke survivors with HF had a lower LVEF and higher LV mass than those without HF. Incident HF in stroke survivors was associated with a HR of 1.8 (95% CI 1.6-1.9, P < .0001) for mortality.
Conclusion:
Incident HF is common in stroke survivors and strongly associates with mortality. The risk of HF varies greatly depending on underlying risk factors. Exploratory analyses suggest that stroke survivors with HF may have a lower ejection fraction phenotype. Future trials of HF preventive therapy in high-risk stroke survivors are warranted.
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