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Abouzid MR, Kamel I, Saleh A, Vidal Margenat A, Hariharan R. Assessing Stroke and Mortality Risk in Heart Failure: The CHA2DS2-VASc Score's Prognostic Value in Patients With and Without Atrial Fibrillation: A Meta-Analysis. Cardiol Rev 2024:00045415-990000000-00301. [PMID: 39145638 DOI: 10.1097/crd.0000000000000749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/16/2024]
Abstract
The CHA2DS2-VASc [congestive heart failure, hypertension, age (≥75 years earns 2 points, 65-74 years earns 1 point), diabetes mellitus, prior stroke, transient ischemic attack, or thromboembolism (2 points), vascular disease (eg, prior myocardial infarction, peripheral artery disease), and female sex category] score has demonstrated potential as a prognostic indicator for adverse outcomes in patients with heart failure (HF). This systematic review and meta-analysis aimed to assess the predictive accuracy of the CHA2DS2-VASc score in determining the occurrence of stroke and mortality in HF patients. We did a thorough search of electronic databases until December 2023. Included studies examined the correlation between the CHA2DS2-VASc score and the likelihood of stroke or death in patients with HF. The meta-analysis showed a substantial correlation between elevated CHA2DS2-VASc scores and heightened risks of both stroke and mortality in HF patients. Patients with CHA2DS2-VASc scores ≥4 had a greater stroke risk than those with scores <4 (odds ratio, 0.38, 95% confidence interval, 0.33-0.43, P < 0.00001). Similarly, patients with CHA2DS2-VASc scores ≥4 had a higher mortality risk (OR, 0.49, 95% confidence interval, 0.30-0.80, P = 0.05). The CHA2DS2-VASc score is a useful predictive tool for identifying HF patients who are at a high risk of both stroke and mortality. Additional investigation is necessary to confirm these findings and examine the incorporation of the CHA2DS2-VASc score into risk assessment algorithms for tailored patient management.
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Affiliation(s)
| | - Ibrahim Kamel
- Steward Carney, Tufts school of medicine, Boston, MA
| | - Amr Saleh
- Yale School of Medicine, New Haven, CT
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Sterba A, Sedova P, Brown RD, Stehlik A, Bryndziar T, Cimflova P, Zvolsky M, Belaskova S, Kovacova I, Bednarik J, Mikulík R. Predictors of spontaneous intracerebral hemorrhage mortality: a community-based study in Brno, Czech Republic. Acta Neurol Belg 2024:10.1007/s13760-024-02612-y. [PMID: 39102105 DOI: 10.1007/s13760-024-02612-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 07/13/2024] [Indexed: 08/06/2024]
Abstract
BACKGROUND AND OBJECTIVE Intracerebral hemorrhage (ICH) is a serious medical condition with high mortality. However, factors leading to long-term mortality after ICH are largely unclear. The aim of this community-based study is to assess predictors of long-term mortality after spontaneous ICH. METHODS We identified all patients admitted with spontaneous ICH to hospitals with a certified stroke unit in Brno, the second largest city in the Czech Republic (CR), in 2011, the year of the Czech Population and Housing Census. We reviewed their medical records for risk factors, radiographic parameters, and measures of post-stroke neurological deficit [National Institutes of Health Stroke Scale (NIHSS)]. Using the dates of death from the Czech National Mortality Register, we calculated mortality at 30 days, six months, one year, and three years after the ICH. Multivariate analysis with forward stepwise logistic regression was performed to determine independent predictors of mortality (p < 0.05). RESULTS In 2011, 1086 patients with stroke were admitted to the four stroke-certified hospitals in Brno, CR. Of these, 134 had spontaneous ICH, with complete data available in 93 of them entering the final analysis. The mortality at 30 days, 6 months, 1 year, and 3 years post-ICH was 34%, 47%, 51%, and 63%, respectively. The mortality was highest in the first few days post-event, with 50% of patients dying in 255 days and average survival being 884 ± 90 days. Both NIHSS and modified ICH (MICH) score showed to be strong and reliable predictors of short- as well as long-term mortality; the risk of death post-ICH increased with older age and size of ICH. Other risk factors contributing to higher, primarily shorter-term mortality included history of cardiac failure, myocardial infarction, or atrial fibrillation. CONCLUSIONS In our community-based study, we found that severity of neurological deficit at admission (NIHSS), combined with age and size of ICH, well predicted short- as well as long-term mortality after spontaneous ICH. A history of cardiac failure, myocardial infarction, or atrial fibrillation at presentation were also predictors of mortality, underscoring the need for optimal cardiac management in patients with ICH.
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Affiliation(s)
- Albert Sterba
- International Clinical Research Center, St Anne's University Hospital, Brno, Czech Republic
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Neurosurgical Clinic, Kralovske Vinohrady University Hospital, Prague, Czech Republic
- Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Petra Sedova
- International Clinical Research Center, St Anne's University Hospital, Brno, Czech Republic.
- Faculty of Medicine, Masaryk University, Brno, Czech Republic.
- Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic.
- Department of Neurology, Mayo Clinic, Rochester, MN, USA.
| | - Robert D Brown
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Albert Stehlik
- International Clinical Research Center, St Anne's University Hospital, Brno, Czech Republic
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Tomas Bryndziar
- International Clinical Research Center, St Anne's University Hospital, Brno, Czech Republic
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Petra Cimflova
- International Clinical Research Center, St Anne's University Hospital, Brno, Czech Republic
- Clinic of Imaging Methods, St Anne's University Hospital, Brno, Czech Republic
| | - Miroslav Zvolsky
- Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
| | - Silvie Belaskova
- International Clinical Research Center, St Anne's University Hospital, Brno, Czech Republic
| | - Ingrid Kovacova
- International Clinical Research Center, St Anne's University Hospital, Brno, Czech Republic
| | - Josef Bednarik
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Neurological Clinic, University Hospital Brno, Brno, Czech Republic
| | - Robert Mikulík
- International Clinical Research Center, St Anne's University Hospital, Brno, Czech Republic
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Neurological Clinic, St Anne's University Hospital, Brno, Czech Republic
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Tütüncü S, Olma MC, Kunze C, Dietzel J, Schurig J, Rosenkranz M, Stingele R, Maschke M, Heuschmann PU, Kirchhof P, Laufs U, Nabavi DG, Röther J, Thomalla G, Veltkamp R, Endres M, Haeusler KG. Heart failure, recurrent vascular events and death in patients with ischemic stroke-results of the MonDAFIS study. Intern Emerg Med 2024:10.1007/s11739-024-03594-8. [PMID: 38619714 DOI: 10.1007/s11739-024-03594-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 03/20/2024] [Indexed: 04/16/2024]
Abstract
Heart failure (HF) is associated with poor outcome after stroke, but data from large prospective trials are sparse.We assessed the impact of HF on clinical endpoints in patients hospitalized with acute ischemic stroke or transient ischemic attack (TIA) enrolled in the prospective, multicenter Systematic Monitoring for Detection of Atrial Fibrillation in Patients with Acute Ischemic Stroke (MonDAFIS) trial. HF was defined as left ventricular ejection fraction (LVEF) < 55% or a history of HF on admission. The composite of recurrent stroke, major bleeding, myocardial infarction, and all-cause death, and its components during the subsequent 24 months were assessed. We used estimated hazard ratios in confounder-adjusted models. Overall, 410/2562 (16.0%) stroke patients fulfilled the HF criteria (i.e. 381 [14.9%] with LVEF < 55% and 29 [1.9%] based on medical history). Patients with HF had more often diabetes, coronary and peripheral arterial disease and presented with more severe strokes on admission. HF at baseline correlated with myocardial infarction (HR 2.21; 95% CI 1.02-4.79), and all-cause death (HR 1.67; 95% CI 1.12-2.50), but not with major bleed (HR 1.93; 95% CI 0.73-5.06) or recurrent stroke/TIA (HR 1.08; 95% CI 0.75-1.57). The data were adjusted for age, stroke severity, cardiovascular risk factors, and randomization. Patients with ischemic stroke or TIA and comorbid HF have a higher risk of myocardial infarction and death compared with non-HF patients whereas the risk of recurrent stroke or major hemorrhage was similar. Trial registration number Clinicaltrials.gov NCT02204267.
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Affiliation(s)
- Serdar Tütüncü
- Center for Stroke Research Berlin, Charité, Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Manuel C Olma
- Center for Stroke Research Berlin, Charité, Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Klinik und Hochschulambulanz für Neurologie mit Abteilung für Experimentelle Neurologie, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Claudia Kunze
- Center for Stroke Research Berlin, Charité, Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Joanna Dietzel
- Center for Stroke Research Berlin, Charité, Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Johannes Schurig
- Center for Stroke Research Berlin, Charité, Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Michael Rosenkranz
- Klinik für Neurologie und Neurologische Frührehabilitation, Albertinen-Krankenhaus Hamburg, Hamburg, Germany
| | - Robert Stingele
- Department of Neurology, German Red Cross Hospital Berlin Köpenick, Berlin, Germany
| | - Matthias Maschke
- Krankenhaus der Barmherzigen Brüder Trier, Klinik für Neurologie und Neurophysiologie, Trier, Germany
| | - Peter U Heuschmann
- Institute of Clinical Epidemiology and Biometry, University Würzburg, Würzburg, Germany
- Comprehensive Heart Failure Center & Clinical Trial Centre Würzburg, University Hospital Würzburg, Würzburg, Germany
| | - Paulus Kirchhof
- German Atrial Fibrillation Network (AFNET), Münster, Germany
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, Medical School, University of Birmingham, Birmingham, UK
- Department of Cardiology, UHB and SWBH NHS Trusts, Birmingham, UK
- University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Ulrich Laufs
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Darius G Nabavi
- Department of Neurology, Vivantes Klinikum Neukölln, Berlin, Germany
| | - Joachim Röther
- Department of Neurology, Asklepios Klinik Altona, Hamburg, Germany
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Roland Veltkamp
- Department of Neurology, Alfried Krupp Krankenhaus, Essen, Germany
- Department of Brain Sciences, Imperial College London, London, UK
| | - Matthias Endres
- Center for Stroke Research Berlin, Charité, Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Klinik und Hochschulambulanz für Neurologie mit Abteilung für Experimentelle Neurologie, Charité-Universitätsmedizin Berlin, Berlin, Germany
- German Center for Neurodegenerative Diseases, Partner Site Berlin, Berlin, Germany
- German Center for Cardiovascular Diseases, Partner Site Berlin, Berlin, Germany
- Excellence Cluster NeuroCure, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
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Heart Failure Status among Acute Ischemic Stroke Patients: A Hospital-Based Study. Neurol Res Int 2022; 2022:7348505. [PMID: 36059928 PMCID: PMC9433237 DOI: 10.1155/2022/7348505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 08/07/2022] [Indexed: 11/24/2022] Open
Abstract
Background Since heart failure (HF) and ischemic stroke have common risk factors, their concurrent occurrence is likely. Strokes in HF patients could be life-threatening and lead to severe disabilities, longer hospitalization time, and mortality. The present study aims to investigate the prevalence of HF and its severity based on ejection fraction (EF) in patients with acute ischemic stroke. Methods The present cross-sectional study included acute ischemic stroke patients admitted to Shahid Rajaei hospital in Karaj in 2020–2021. The diagnosis of HF was based on transthoracic echocardiography within 48 hours of symptom onset, and HF was classified into two groups: 41–49% as mildly reduced EF (HFmrEF) and ≤40% as reduced EF (HFrEF). Patients who did not complete cardiac studies were excluded. Results 257 acute ischemic stroke patients (62.6% male) were included. Among stroke patients, the prevalence of HF, including HFrEF and HFmrEF, was 30.0% (95% CI: 21.4–38.6). HFmrEF and HFrEF was diagnosed in 32 (12.5%) and 45 (17.5%) patients, respectively. HF was significantly associated with older age, hypertension, past myocardial infarction (MI), and arrhythmia. A history of previous MI significantly increased the odds of heart failure (OR: 3.25, 95% CI: 1.82–5.81). Conclusion There is a high prevalence of HF among acute ischemic stroke patients. Older patients with a history of hypertension and previous MI are at higher risk. Since patients with HF have a higher mortality and morbidity rate after experiencing an ischemic stroke, close cooperation between the neurology and cardiology specialists for providing advanced care for survivors is required.
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Predicting 10-year stroke mortality: development and validation of a nomogram. Acta Neurol Belg 2022; 122:685-693. [PMID: 34406610 PMCID: PMC9170668 DOI: 10.1007/s13760-021-01752-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 07/12/2021] [Indexed: 11/02/2022]
Abstract
Predicting long-term stroke mortality is a clinically important and unmet need. We aimed to develop and internally validate a 10-year ischaemic stroke mortality prediction score. In this UK cohort study, 10,366 patients with first-ever ischaemic stroke between January 2003 and December 2016 were followed up for a median (interquartile range) of 5.47 (2.96-9.15) years. A Cox proportional-hazards model was used to predict 10-year post-admission mortality. The predictors associated with 10-year mortality included age, sex, Oxfordshire Community Stroke Project classification, estimated glomerular filtration rate (eGFR), pre-stroke modified Rankin Score, admission haemoglobin, sodium, white blood cell count and comorbidities (atrial fibrillation, coronary heart disease, heart failure, cancer, hypertension, chronic obstructive pulmonary disease, liver disease and peripheral vascular disease). The model was internally validated using bootstrap resampling to assess optimism in discrimination and calibration. A nomogram was created to facilitate application of the score at the point of care. Mean age (SD) was 78.5 ± 10.9 years, 52% female. Most strokes were partial anterior circulation syndromes (38%). 10-year mortality predictors were: total anterior circulation stroke (hazard ratio, 95% confidence intervals) (2.87, 2.62-3.14), eGFR < 15 (1.97, 1.55-2.52), 1-year increment in age (1.04, 1.04-1.05), liver disease (1.50, 1.20-1.87), peripheral vascular disease (1.39, 1.23-1.57), cancers (1.37, 1.27-1.47), heart failure (1.24, 1.15-1.34), 1-point increment in pre-stroke mRS (1.20, 1.17-1.22), atrial fibrillation (1.17, 1.10-1.24), coronary heart disease (1.09, 1.02-1.16), chronic obstructive pulmonary disease (1.13, 1.03-1.25) and hypertension (0.77, 0.72-0.82). Upon internal validation, the optimism-adjusted c-statistic was 0.76 and calibration slope was 0.98. Our 10-year mortality model uses routinely collected point-of-care information. It is the first 10-year mortality score in stroke. While the model was internally validated, further external validation is also warranted.
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Tiamkao S, Ienghong K, Cheung LW, Celebi I, Suzuki T, Apiratwarakul K. Stroke Incidence, Rate of Thrombolytic Therapy, Mortality in Thailand from 2009 to 2021. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.8051] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Thrombolytic treatment is the main treatment of acute ischemic stroke. Thailand started thrombolytic treatment in 2008 only at university hospitals in Bangkok and gradually increased services in large provincial hospitals until widespread in 2014. However, no studies regard the services in stroke management in Thailand.
AIM: This study aims to present data: incidence, rate of thrombolytic treatment, mortality rate of acute stroke in Thailand for 13 years
METHODS: A study from the National Health Security Office's database between 2009 and 2021 was reported using percentage statistics, and the number of patients per 100,000 population.
RESULTS: The overall incidence of acute stroke patients aged 15 years and over was 172.33- 328.00 per 100,000 population. The incidence of acute ischemic stroke patients aged 15 years and over was 90.37-222.73 per 100,000 population. The incidence of non-traumatic intracerebral hemorrhage patients aged 15 years and over was 55.77-87.63 per 100,000 population. Rate of acute ischemic stroke patients who treated with thrombolytic treatment was 0.18-8.04%. Mortality rate of acute stroke patients was 10.24-14.77%. Mortality rate of acute ischemic stroke patients who treated with thrombolytic treatment was 3.97-10.53%.
CONCLUSIONS: Stroke incidence tends to increase over 13 years. Acute ischemic stroke patients receiving thrombolytic treatment tends to increase in number. The mortality rate in patients with acute stroke tends to decline. Especially in patients with acute ischemic stroke, the mortality rate was greatly reduced.
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M'barek L, Sakka S, Megdiche F, Farhat N, Maalla K, Turki D, Feki S, Rebai A, Dammak M, Kallel C, Mhiri C. Traditional risk factors and combined genetic markers of recurrent ischemic stroke in adults. J Thromb Haemost 2021; 19:2596-2604. [PMID: 34241942 DOI: 10.1111/jth.15448] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 07/06/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND The involvement of traditional risk factors and combined genetic markers of recurrent arterial ischemic stroke (AIS) in adults remains unclear. OBJECTIVE This study aims to determine significant clinical and genetic factors of AIS recurrence, and to investigate the combined effect of genotypes on the occurrence of a second cerebral ischemic attack. METHODS We investigated a cohort study of AIS patients (18-50 years old) followed in the neurology department over 5 years. Traditional and genetic risk factors were carried through a multivariable logistic regression model. We used a Cox proportional hazard model for identifying predictors of recurrence. RESULTS Two hundred and seventy patients were enrolled in our study. The risk of AIS recurrence was 36.2% within 5 years. The potential risk of recurrence of AIS increased with traditional and genetic risk factors such as hypertension, diabetes mellitus, heart failure, and family history of cerebrovascular diseases. This risk increased with increasing number of genetic factors. The hazard ratio (HR) was 0.66 (95% confidence interval [CI] 0.97-2.67) for the subject with one genetic factor, 1.61 (95% CI 0.97-2.25) for combined methylenetetrahydrofolate reductase (MTHFR) polymorphisms, and 2.57 (95% CI 1.32-4.99) for combined factor V Leiden (FVL) and MTHFR polymorphisms (677 or 1298). The HR for the three polymorphisms combined was 6.04 (95% CI 2.40-15.16). CONCLUSIONS Our findings suggest that cumulative effect of both traditional and common genetic risk factors was associated with recurrence of ischemic stroke. We demonstrated for the first time that a combined genotype FVL/MTHFR profile increase the risk of a second cerebral ischemic attack.
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Affiliation(s)
- Lamia M'barek
- Laboratory of Neurogenetics, Parkinson's Disease and Cerebrovascular Disease (LR-12-SP-19), University of Sfax, Sfax, Tunisia
- Clinical Investigation Center (CIC), Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Salma Sakka
- Laboratory of Neurogenetics, Parkinson's Disease and Cerebrovascular Disease (LR-12-SP-19), University of Sfax, Sfax, Tunisia
| | - Fatma Megdiche
- Laboratory of Hematology, Habib Bourguiba University Hospital, Sfax, Tunisia
- Faculty of Pharmacy, University of Monastir, Monastir, Tunisia
| | - Nouha Farhat
- Laboratory of Neurogenetics, Parkinson's Disease and Cerebrovascular Disease (LR-12-SP-19), University of Sfax, Sfax, Tunisia
| | - Khadija Maalla
- Laboratory of Neurogenetics, Parkinson's Disease and Cerebrovascular Disease (LR-12-SP-19), University of Sfax, Sfax, Tunisia
| | - Dhaker Turki
- Laboratory of Neurogenetics, Parkinson's Disease and Cerebrovascular Disease (LR-12-SP-19), University of Sfax, Sfax, Tunisia
| | - Sawsan Feki
- Autoimmunity, Cancer and Immunogenetics" Research Laboratory (LR18SP12), Immunology Department, Habib Bourguiba Hospital, University of Sfax, Sfax, Tunisia
| | - Ahmed Rebai
- Molecular and Cellular Screening Process Laboratory, Centre of Biotechnology of Sfax, Sfax, Tunisia
| | - Mariem Dammak
- Laboratory of Neurogenetics, Parkinson's Disease and Cerebrovascular Disease (LR-12-SP-19), University of Sfax, Sfax, Tunisia
| | - Choumous Kallel
- Laboratory of Hematology, Habib Bourguiba University Hospital, Sfax, Tunisia
- Faculty of Pharmacy, University of Monastir, Monastir, Tunisia
| | - Chokri Mhiri
- Laboratory of Neurogenetics, Parkinson's Disease and Cerebrovascular Disease (LR-12-SP-19), University of Sfax, Sfax, Tunisia
- Clinical Investigation Center (CIC), Habib Bourguiba University Hospital, Sfax, Tunisia
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Pana TA, Dawson DK, Mohamed MO, Murray F, Fischman DL, Savage MP, Mamas MA, Myint PK. Sex Differences in Ischemic Stroke Outcomes in Patients With Pulmonary Hypertension. J Am Heart Assoc 2021; 10:e019341. [PMID: 33682439 PMCID: PMC8174217 DOI: 10.1161/jaha.120.019341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 01/26/2021] [Indexed: 01/20/2023]
Abstract
Background The association between systemic hypertension and cerebrovascular disease is well documented. However, the impact of pulmonary hypertension (PH) on acute ischemic stroke outcomes is unknown despite PH being recognized as a risk factor for acute ischemic stroke. We aimed to determine the association between PH and adverse in-hospital outcomes after acute ischemic stroke, as well as whether there are sex differences in this association. Methods and Results Acute ischemic stroke admissions from the US National Inpatient Sample between October 2015 and December 2017 were included. The relationship between PH and outcomes (mortality, prolonged hospitalization >4 days, and routine home discharge) was analyzed using logistic regressions adjusting for demographics, comorbidities, and revascularization therapies. Interaction terms between PH and sex and age groups were also included. A total of 221 249 records representative of 1 106 045 admissions were included; 2.9% of patients had co-morbid PH, and 35.34% of those were male. PH was not associated with in-hospital mortality (odds ratio [OR], 0.96; 95% CI, 0.86-1.09) but was associated with increased odds of prolonged hospitalization (OR, 1.15; 95% CI, 1.09-1.22) and decreased odds of routine discharge (OR, 0.87; 95% CI, 0.81-0.94) for both sexes. Older patients with PH were significantly less likely to be discharged routinely (P=0.028) than their younger counterparts. Compared with female patients with PH, men were 31% more likely to die in hospital (P=0.024). Conclusions PH was not significantly associated with in-hospital mortality but was associated with prolonged hospitalization and adverse discharge status. Male patients with PH were more likely to die in hospital than female patients.
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Affiliation(s)
- Tiberiu A. Pana
- Keele Cardiovascular Research GroupCentre for Prognosis ResearchInstitute for Primary Care and Health SciencesKeele UniversityStoke‐on‐TrentUK
- Institute of Applied Health SciencesSchool of MedicineMedical Sciences & NutritionUniversity of AberdeenAberdeenUK
- Institute of Medical SciencesSchool of MedicineMedical Sciences & NutritionUniversity of AberdeenAberdeenUK
| | - Dana K. Dawson
- Institute of Applied Health SciencesSchool of MedicineMedical Sciences & NutritionUniversity of AberdeenAberdeenUK
| | - Mohamed O. Mohamed
- Keele Cardiovascular Research GroupCentre for Prognosis ResearchInstitute for Primary Care and Health SciencesKeele UniversityStoke‐on‐TrentUK
| | - Fiona Murray
- Institute of Medical SciencesSchool of MedicineMedical Sciences & NutritionUniversity of AberdeenAberdeenUK
| | | | | | - Mamas A. Mamas
- Keele Cardiovascular Research GroupCentre for Prognosis ResearchInstitute for Primary Care and Health SciencesKeele UniversityStoke‐on‐TrentUK
| | - Phyo K. Myint
- Keele Cardiovascular Research GroupCentre for Prognosis ResearchInstitute for Primary Care and Health SciencesKeele UniversityStoke‐on‐TrentUK
- Institute of Applied Health SciencesSchool of MedicineMedical Sciences & NutritionUniversity of AberdeenAberdeenUK
- Institute of Medical SciencesSchool of MedicineMedical Sciences & NutritionUniversity of AberdeenAberdeenUK
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Pana TA, Mohamed MO, Clark AB, Fahy E, Mamas MA, Myint PK. Revascularisation therapies improve the outcomes of ischemic stroke patients with atrial fibrillation and heart failure. Int J Cardiol 2020; 324:205-213. [PMID: 33022289 DOI: 10.1016/j.ijcard.2020.09.076] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 08/28/2020] [Accepted: 09/30/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) and heart failure (HF) carry a poor prognosis in acute ischaemic stroke (AIS). The impact of revascularisation therapies on outcomes in these patients is not fully understood. METHOD National Inpatient Sample (NIS) AIS admissions (January 2004-September 2015) were included (n = 4,597,428). Logistic regressions analysed the relationship between exposures (neither AF nor HF-reference, AF-only, HF-only, AF + HF) and outcomes (in-hospital mortality, length-of-stay >median and moderate-to-severe disability on discharge), stratifying by receipt of intravenous thrombolysis (IVT) or endovascular thrombectomy (ET). RESULTS 69.2% patients had neither AF nor HF, 16.5% had AF-only, 7.5% had HF-only and 6.7% had AF + HF. 5.04% and 0.72% patients underwent IVT and/or ET, respectively. AF-only and HF-only were each associated with 75-85% increase in the odds of in-hospital mortality. AF + HF was associated with greater than two-fold increase in mortality. Patients with AF-only, HF-only or AF + HF undergoing IVT had better or at least similar in-hospital outcomes compared to their counterparts not undergoing IVT, except for prolonged hospitalisation. Patients undergoing ET with AF-only, HF-only or AF + HF had better (in-hospital mortality, discharge disability, all-cause bleeding) or at least similar (length-of-stay) outcomes to their counterparts not undergoing ET. Compared to AIS patients without AF, AF patients had approximately 50% and more than two-fold increases in the likelihood of receiving IVT or ET, respectively. CONCLUSIONS We confirmed the combined and individual impact of co-existing AF or HF on important patient-related outcomes. Revascularisation therapies improve these outcomes significantly in patients with these comorbidities.
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Affiliation(s)
- Tiberiu A Pana
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Stoke-on-Trent, United Kingdom; Institute of Applied Health Sciences, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, United Kingdom
| | - Mohamed O Mohamed
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Stoke-on-Trent, United Kingdom
| | - Allan B Clark
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Eoin Fahy
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Stoke-on-Trent, United Kingdom
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Stoke-on-Trent, United Kingdom
| | - Phyo K Myint
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Stoke-on-Trent, United Kingdom; Institute of Applied Health Sciences, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, United Kingdom; Norwich Medical School, University of East Anglia, Norwich, United Kingdom.
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