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Revascularisation Therapies Improve the Outcomes of Ischemic Stroke Patients with Atrial Fibrillation and Heart Failure

Mamas

Revascularisation Therapies Improve the Outcomes of Ischemic Stroke Patients with Atrial Fibrillation and Heart Failure Thumbnail


Authors



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.

Methods –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 HFonly 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 AFonly, 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.

Citation

Mamas. (2021). Revascularisation Therapies Improve the Outcomes of Ischemic Stroke Patients with Atrial Fibrillation and Heart Failure. International Journal of Cardiology, 205-213. https://doi.org/10.1016/j.ijcard.2020.09.076

Acceptance Date Oct 1, 2020
Publication Date Feb 1, 2021
Journal International Journal of Cardiology
Print ISSN 0167-5273
Publisher Elsevier
Pages 205-213
DOI https://doi.org/10.1016/j.ijcard.2020.09.076
Keywords revascularisation, therapies, ischemic stroke, atrial fibrillation, heart failure
Publisher URL http://doi.org/10.1016/j.ijcard.2020.09.076