Tools
ToolsPana, Tiberiu A., McLernon, David J, Mamas, Mamas A., Bettencourt Da Silva, Joao, Metcalf, Anthony K., Potter, John and Myint, Phyo (2019) Individual and combined impact of heart failure and atrial fibrillation on ischaemic stroke outcomes: a prospective hospital register cohort study. Stroke, 50 (7). 1838–1845. ISSN 0039-2499
Preview |
PDF (Accepted_Manuscript)
- Accepted Version
Download (1MB) | Preview |
Abstract
Background and Purpose— We aimed to determine individual and combined effects of atrial fibrillation (AF) and heart failure (HF) on acute ischemic stroke outcomes: in-hospital mortality, length-of-stay, and poststroke disability; long-term mortality and stroke recurrence. Methods— Prospective cohort study of patients with acute ischemic stroke admitted to a UK center with a catchment population of ≈900 000 between 2004 and 2016. Exposure groups were patients with neither AF nor HF (reference group), those with AF but without HF, those with HF but without AF, and those with AF+HF. Logistic and Cox regressions were used to model in-hospital and long-term outcomes, respectively. Results— A total of 10 816 patients with a mean age±SD =77.9±12.1 years, 48% male were included. Only 30 (4.9%) of the patients with HF but not AF were anticoagulated at discharge. Both AF (odds ratio, 1.24 [95% CI, 1.07–1.43]), HF (odds ratio, 1.40 [1.10–1.79]), and their combination (odds ratio, 2.23 [1.83–2.72]) were associated with increased odds of in-hospital mortality. All 3 exposure groups were associated with increased length-of-stay, while only AF predicted increased disability (1.36 [1.12–1.64]). Patients were followed for a median of 5.5 and 3.7 years for mortality and recurrence, respectively. Long-term mortality was associated with AF (hazard ratio, 1.45 [95% CI, 1.33–1.59]), HF (2.07 [1.83–2.36]), and their combination (2.20 [1.96–2.46]). Recurrent stroke was associated with AF 1.50 (1.26–1.78), HF (1.33 [1.01–1.75]), and AF with HF (1.62 [1.28–2.07]). Conclusions— The AF-associated excess risk of stroke recurrence was independent of comorbid HF. HF without AF was also associated with a significant risk of recurrence. Anticoagulation for secondary stroke prevention in patients with HF without AF may require further evaluation in a clinical trial setting.
| Item Type: | Article |
|---|---|
| Faculty \ School: | Faculty of Medicine and Health Sciences > Norwich Medical School |
| UEA Research Groups: | Faculty of Medicine and Health Sciences > Research Groups > Nutrition and Preventive Medicine Faculty of Medicine and Health Sciences > Research Groups > Cardiovascular and Metabolic Health |
| Depositing User: | LivePure Connector |
| Date Deposited: | 17 Apr 2019 14:30 |
| Last Modified: | 21 Oct 2022 22:36 |
| URI: | https://ueaeprints.uea.ac.uk/id/eprint/70613 |
| DOI: | 10.1161/STROKEAHA.119.025481 |
Downloads
Downloads per month over past year
Actions (login required)
 |
View Item |