Clinical characteristics, precipitating factors, management and outcome of patients with prior stroke hospitalised with heart failure: an observational report from the Middle East

• Published in: BMJ open 2015-04, Vol.5 (4), p.e007148-e007148
• Main Authors: Khafaji, Hadi A R, Sulaiman, Kadhim, Singh, Rajvir, AlHabib, Khalid F, Asaad, Nidal, Alsheikh-Ali, Alawi, Al-Jarallah, Mohammed, Bulbanat, Bassam, AlMahmeed, Wael, Ridha, Mustafa, Bazargani, Nooshin, Amin, Haitham, Al-Motarreb, Ahmed, AlFaleh, Hussam, Elasfar, Abdelfatah, Panduranga, Prashanth, Al Suwaidi, Jassim
• Format: Article
• Language: English
• Subjects: Aged; Atrial Fibrillation - epidemiology; Cardiology; Cardiovascular disease; Cardiovascular Medicine; Cohort Studies; Comorbidity; Coronary vessels; Diabetes; Disease Management; Female; Heart failure; Heart Failure - mortality; Heart Failure - therapy; Hospital Mortality; Hospitalization; Humans; Hyperlipidemias - epidemiology; Hypertension; Hypertension - epidemiology; Hypertrophy, Left Ventricular - epidemiology; Internal Medicine; Ischemia; Kidney diseases; Length of Stay; Logistic Models; Male; Middle Aged; Middle East - epidemiology; Morbidity; Mortality; Multivariate Analysis; Myocardial Ischemia - epidemiology; Patients; Peripheral Arterial Disease - epidemiology; Precipitating Factors; Prevalence; Prognosis; Prospective Studies; Recurrence; Registries; Renal Insufficiency, Chronic - epidemiology; Retrospective Studies; Risk Factors; Smoking - epidemiology; Stroke; Stroke - epidemiology; Transient ischemic attack; Variables; Vein & artery diseases; Ventricular Dysfunction, Left - epidemiology
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2014-007148

Objectives The purpose of this study is to report the prevalence, clinical characteristics, precipitating factors, management and outcome of patients with prior stroke hospitalised with acute heart failure (HF). Design Retrospective analysis of prospectively collected data. Setting Data were derived from Gulf CARE (Gulf aCute heArt failuRe rEgistry), a prospective multicentre study of consecutive patients hospitalised with acute HF in 2012 in seven Middle Eastern countries and analysed according to the presence or absence of prior stroke; demographics, management and outcomes were compared. Participants A total of 5005 patients with HF. Outcome measures In-hospital and 1-year outcome. Results The prevalence of prior stroke in patients with HF was 8.1%. Patients with stroke with HF were more likely to be admitted under the care of internists rather than cardiologists. When compared with patients without stroke, patients with stroke were more likely to be older and to have diabetes mellitus, hypertension, atrial fibrillation, hyperlipidaemia, chronic kidney disease, ischaemic heart disease, peripheral arterial disease and left ventricular dysfunction (p=0.001 for all). Patients with stroke were less likely to be smokers (0.003). There were no significant differences in terms of precipitating risk factors for HF hospitalisation between the two groups. Patients with stroke with HF had a longer hospital stay (mean±SD days; 11±14 vs 9±13, p=0.03), higher risk of recurrent strokes and 1-year mortality rates (32.7% vs 23.2%, p=0.001). Multivariate logistic regression analysis showed that stroke is an independent predictor of in-hospital and 1-year mortality. Conclusions This observational study reports high prevalence of prior stroke in patients hospitalised with HF. Internists rather than cardiologists were the predominant caregivers in this high-risk group. Patients with stroke had higher risk of in-hospital recurrent strokes and long-term mortality rates. Trial registration number NCT01467973.