Heart Failure in Acute Ischaemic Stroke and Intracerebral Haemorrhage - impact on mortality and recurrence A Thailand National Stroke Cohort Study

Pana, T.; Wood, A.; Perdomo-Lampignano, J.; Tiamkao, S.; Clark, A.; Kongbunkiat, K.; Bettencourt-Silva, J.; Sawanyawisuth, K.; Kasemsap, N.; Mamas, M.; Myint, P.

Abstract

Background: The interaction between heart failure (HF) and acute cerebrovascular disease is unclear. Data on acute ischaemic stroke (AIS) recurrence and intracerebral haemorrhage (ICH) mortality and recurrence in HF patients are limited. We thus aimed to establish the influence of co-morbid HF on in-hospital and post-discharge outcomes in AIS and ICH patients.

Methods: We extracted data of all stroke hospital admissions from Thailand between 2004 and 2015. Logistic regressions were used to quantify the effect of HF on in-hospital mortality and recurrence in stroke patients. A multi-state model was constructed to accurately predict the influence of HF on the typical disease course of a stroke patient: baseline – (recurrence) - death (Figure 1). All models were constructed using flexible parametric survival techniques. Analyses were adjusted for age, sex and a comprehensive range of cardiovascular risk factors and co-morbidities. Results: 608,890 cases were included (370,527 AIS, 173,236 ICH and 65,127 Undetermined). HF was associated with increased odds of in-hospital death for AIS (OR[99%CI]=2.26[2.12-2.41]) and ICH (1.39[1.24-1.55]). First-ever stroke presentations (527,360) were included in the multi-state analysis (Figure 2). Patients were followed up for a total of 1,594,076 patient-years. HF was associated with an increase in post-discharge mortality in AIS (HR[99%CI]=1.54[1.48-1.61]) and ICH (2.10[1.47-3.00]). HF was associated with AIS recurrence (1.19[1.00-1.42]) and ICH recurrence (1.75[1.10-2.77]) in the short-term post-discharge (6 months-1 year and 1-2 years respectively).

Conclusions: Co-morbid HF increases the risk of in-hospital and post-discharge death for all stroke types, with a more pronounced effect in ICH patients. We are the first study to report on a high-risk period for HF patients in the short-term post-discharge. Stroke patients with HF may thus benefit from more intensive disease management shortly after hospital discharge.

Citation

Pana, T., Wood, A., Perdomo-Lampignano, J., Tiamkao, S., Clark, A., Kongbunkiat, K., …Myint, P. (2018, April). Heart Failure in Acute Ischaemic Stroke and Intracerebral Haemorrhage - impact on mortality and recurrence A Thailand National Stroke Cohort Study. Paper presented at 27th European Stroke Conference

• Presentation Conference Type: Conference Paper (unpublished)
• Conference Name: 27th European Stroke Conference
• Start Date: Apr 11, 2018
• End Date: Apr 13, 2018
• Deposit Date: Jun 23, 2023
• Publisher URL: https://karger.com/ced/article/45/Suppl.%201/0/58269/European-Stroke-Conference-Athens-April-11-13-2018