Heart failure, recurrent vascular events and death in patients with ischemic stroke-results of the MonDAFIS study
Tütüncü, Serdar Olma, Manuel C Kunze, Claudia Dietzel, Joanna Schurig, Johannes Rosenkranz, Michael Stingele, Robert Maschke, Matthias Heuschmann, Peter U
Tütüncü, Serdar
Olma, Manuel C
Kunze, Claudia
Dietzel, Joanna
Schurig, Johannes
Rosenkranz, Michael
Stingele, Robert
Maschke, Matthias
Heuschmann, Peter U
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Affiliation
Universitätsmedizin Berlin; Albertinen-Krankenhaus Hamburg; German Red Cross Hospital Berlin Köpenick; Sandwell and West Birmingham NHS Trust; et al.
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Publication date
2024-04-15
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Abstract
Heart failure (HF) is associated with poor outcome after stroke, but data from large prospective trials are sparse.We assessed the impact of HF on clinical endpoints in patients hospitalized with acute ischemic stroke or transient ischemic attack (TIA) enrolled in the prospective, multicenter Systematic Monitoring for Detection of Atrial Fibrillation in Patients with Acute Ischemic Stroke (MonDAFIS) trial. HF was defined as left ventricular ejection fraction (LVEF) < 55% or a history of HF on admission. The composite of recurrent stroke, major bleeding, myocardial infarction, and all-cause death, and its components during the subsequent 24 months were assessed. We used estimated hazard ratios in confounder-adjusted models. Overall, 410/2562 (16.0%) stroke patients fulfilled the HF criteria (i.e. 381 [14.9%] with LVEF < 55% and 29 [1.9%] based on medical history). Patients with HF had more often diabetes, coronary and peripheral arterial disease and presented with more severe strokes on admission. HF at baseline correlated with myocardial infarction (HR 2.21; 95% CI 1.02-4.79), and all-cause death (HR 1.67; 95% CI 1.12-2.50), but not with major bleed (HR 1.93; 95% CI 0.73-5.06) or recurrent stroke/TIA (HR 1.08; 95% CI 0.75-1.57). The data were adjusted for age, stroke severity, cardiovascular risk factors, and randomization. Patients with ischemic stroke or TIA and comorbid HF have a higher risk of myocardial infarction and death compared with non-HF patients whereas the risk of recurrent stroke or major hemorrhage was similar. Trial registration number Clinicaltrials.gov NCT02204267.
Citation
Tütüncü S, Olma MC, Kunze C, Dietzel J, Schurig J, Rosenkranz M, Stingele R, Maschke M, Heuschmann PU, Kirchhof P, Laufs U, Nabavi DG, Röther J, Thomalla G, Veltkamp R, Endres M, Haeusler KG; MonDAFIS Investigators. Heart failure, recurrent vascular events and death in patients with ischemic stroke-results of the MonDAFIS study. Intern Emerg Med. 2024 Apr 15. doi: 10.1007/s11739-024-03594-8
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Article