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Pana, Tiberiu A., Mohamed, Mohamed O., Clark, Allan B. 
ORCID: https://orcid.org/0000-0003-2965-8941, Fahy, Eoin, Mamas, Mamas A. and Myint, Phyo K.
(2021)
Revascularisation therapies improve the outcomes of ischemic stroke patients with atrial fibrillation and heart failure.
International Journal of Cardiology, 324.
pp. 205-213.
ISSN 0167-5273
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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. Method: 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 HF-only 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 AF-only, 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.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | atrial fibrillation,cerebrovascular disease,heart failure,stroke,thrombectomy,thrombolysis,cardiology and cardiovascular medicine ,/dk/atira/pure/subjectarea/asjc/2700/2705 |
| Faculty \ School: | Faculty of Medicine and Health Sciences > Norwich Medical School |
| UEA Research Groups: | Faculty of Medicine and Health Sciences > Research Groups > Epidemiology and Public Health Faculty of Medicine and Health Sciences > Research Groups > Health Services and Primary Care Faculty of Medicine and Health Sciences > Research Groups > Norwich Clinical Trials Unit Faculty of Medicine and Health Sciences > Research Groups > Public Health and Health Services Research |
| Related URLs: | |
| Depositing User: | LivePure Connector |
| Date Deposited: | 06 Oct 2020 23:59 |
| Last Modified: | 22 Oct 2022 07:13 |
| URI: | https://ueaeprints.uea.ac.uk/id/eprint/77152 |
| DOI: | 10.1016/j.ijcard.2020.09.076 |
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