Increased Risk of Heart Failure Among Stroke Survivors: A Nationwide Cohort Study

Background/Objectives: Stroke-induced cardiac damage may lead to lifelong cardiac problems, such as heart failure (HF). We aimed to compare the incidence of HF between stroke survivors and the general non-stroke population. Methods: We performed a population-based study of individuals in the Korean National Health Insurance Service database. We included 220,231 stroke survivors between 2010 and 2018 and 1:1 age- and sex-matched non-stroke controls. The study outcome was HF and the cohort was followed up until 2019. Cox hazards models were used to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for HF risk. Results: At baseline, stroke survivors had a substantially higher comorbidity burden than matched controls (Charlson Comorbidity Index 4.1 vs. 1.6), with higher rates of hypertension, type 2 diabetes, and dyslipidemia, and were more likely to be current smokers and heavy drinkers. Stroke survivors showed a higher risk for HF (aHR 1.69, 95% CI 1.65-1.73) compared to controls. The risks were further increased with disability, as demonstrated in comparison of those with mild disability (aHR 1.78, 95% CI 1.70-1.87) and those with severe disability (aHR 2.22, 95% CI 2.10-2.36). Before applying the 1-year lag period, the association appeared more prominent among hemorrhagic stroke survivors than ischemic stroke survivors. However, following the 1-year lag period, the HF risk was similar between stroke subtypes (hemorrhagic stroke with disability: aHR 1.77, 95% CI 1.62-1.93; ischemic stroke with disability: aHR 1.71, 95% CI 1.63-1.80). Propensity score matching incorporating all baseline characteristics confirmed the robustness of the primary findings. Conclusions: Stroke survivors, who had a greater burden of cardiovascular risk factors, were at significantly greater risk for incident HF compared with age- and sex-matched non-stroke controls, particularly those with disability. Clinicians need to be aware of the importance of HF in stroke survivors who have multiple comorbidities and disability.