Ischemic stroke after heart failure: A community-based study

• Published in: The American heart journal 2006-07, Vol.152 (1), p.102-109
• Main Authors: Witt, Brandi J., Brown, Robert D., Jacobsen, Steven J., Weston, Susan A., Ballman, Karla V., Meverden, Ryan A., Roger, Véronique L.
• Format: Article
• Language: English
• Subjects: Age; Age Factors; Aged; Aged, 80 and over; Aspirin; Atrial Fibrillation - epidemiology; Biological and medical sciences; Body mass index; Brain Ischemia - epidemiology; Brain Ischemia - etiology; Cardiac arrhythmia; Cardiology. Vascular system; Cardiovascular disease; Comorbidity; Diabetes; Diabetes Mellitus - epidemiology; Female; Health care; Heart; Heart failure; Heart Failure - complications; Heart Failure - mortality; Heart failure, cardiogenic pulmonary edema, cardiac enlargement; Humans; Hypertension; Incidence; Male; Medical imaging; Medical sciences; Middle Aged; Minnesota - epidemiology; Mortality; Neurology; NMR; Nuclear magnetic resonance; Older people; Prognosis; Proportional Hazards Models; Stroke; Stroke - etiology; Stroke - mortality; Survival Analysis; Vascular diseases and vascular malformations of the nervous system
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/j.ahj.2005.10.018

Although studies have examined the incidence of stroke in heart failure (HF), their findings are inconsistent and difficult to interpret because of heterogeneity in study design and population. Although HF remains a highly fatal disease, the excess mortality imparted from stroke is unknown. A random sample of cases of HF from 1979 to 1999 was identified and validated according to Framingham criteria. Strokes were identified by screening medical diagnoses and subsequent physician validation. Stroke risk in HF was compared with the risk in the general population with standardized morbidity ratios. Associations between selected characteristics and stroke were examined using proportional hazards regression. The study cohort included 630 persons with incident HF. During a median of 4.3 years of follow-up, 102 (16%) experienced an ischemic stroke. Heart failure was associated with a 17.4-fold increased risk for stroke compared with the general population in the first 30 days after HF diagnosis and remained elevated during 5 years of follow-up. Older persons with prior stroke or diabetes were more likely to experience stroke after HF diagnosis. Persons with stroke after HF were 2.31 times more likely to die compared with persons without stroke. In the community, persons with HF have a large increase in the risk for ischemic stroke compared with the general population. Stroke results in a >2-fold increase in mortality. Thus, prevention of stroke has the potential to improve survival among patients with HF, particularly among the elderly and those with diabetes or prior stroke.