Rheumatic mitral valve disease is associated with worse outcomes in stroke: A Thailand National Database Study

Wood, Adrian D., Mannu, Gurdeep S., Clark, Allan B. ORCID: https://orcid.org/0000-0003-2965-8941, Tiamkao, Somsak, Kongbunkiat, Kannikar, Bettencourt-Silva, Joao H., Sawanyawisuth, Kittisak, Kasemsap, Narongrit, Barlas, Raphae S., Mamas, Mamas and Myint, Phyo Kyaw (2016) Rheumatic mitral valve disease is associated with worse outcomes in stroke: A Thailand National Database Study. Stroke, 47 (11). pp. 2695-2701. ISSN 0039-2499

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Background and purpose: Rheumatic valvular heart disease is associated with increased risk of cerebrovascular events, although there are limited data on the prognosis of patients with rheumatic mitral valve disease (RMVD) following stroke.  Methods: We examined the association between RMVD and both serious and common cardiovascular and non-cardiovascular (respiratory and infective) complications in a cohort of hospitalised stroke patients based in Thailand. Factors associated with in-hospital mortality were also explored. Data were obtained from a National Insurance Database. All hospitalised strokes between 1st October 2004 and 31st January 2013 were included in the current study. Characteristics and outcomes were compared for RMVD and non-RMVD patients. Logistic regression, propensity score matching, and multivariate models were employed to assess study outcomes.  Results: In total, 594,681 patients (mean (SD) age=64(14.5) years) with a diagnosis of stroke (ischemic = 306,154; hemorrhagic= 195,392; undetermined = 93,135) were included in this study, of whom 5461 had RMVD. Results from primary analyses showed that following ischemic stroke, and controlling for potential confounding covariates, RMVD was associated (P<0.001) with increased odds for cardiac arrest (OR(95%CI)=2.13(1.68-2.70)), shock (2.13(1.64-2.77)), arrhythmias (1.70(1.21-2.39)), respiratory failure (2.09(1.87-2.33)), pneumonia (2.00(1.81-2.20)), and sepsis (1.39(1.19-1.63)). In hemorrhagic stroke patients, RMVD was associated with increased odds (fully adjusted model) for respiratory failure (1.26(1.01-1.57)), and in patients with undetermined stroke, RMVD was associated with increased odds (fully adjusted analyses) for shock (3.00(1.46-6.14)), respiratory failure (2.70(1.91-3.79)), and pneumonia (2.42(1.88-3.11)).  Conclusions: RMVD is associated with development of cardiac arrest, shock, arrhythmias, respiratory failure, pneumonia, and sepsis following acute stroke.

Item Type: Article
Uncontrolled Keywords: complications,epidemiology,mortality,rheumatic heart disease,stroke
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
Related URLs:
Depositing User: Pure Connector
Date Deposited: 24 Sep 2016 00:45
Last Modified: 22 Oct 2022 01:30
URI: https://ueaeprints.uea.ac.uk/id/eprint/60209
DOI: 10.1161/STROKEAHA.116.014512

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