Heart Failure Is Associated With Increased Stroke Severity, In-Hospital Mortality, Major Adverse Cardiovascular Events, and Complications: Insights From the Chinese Stroke Center Alliance.

Abstract

Background: Heart failure (HF) constitutes the source of various damaging pathophysiological mechanisms in acute ischemic stroke (AIS). The effect of a previous HF on the in-hospital outcomes for patients with AIS still lacks effective research. We aimed to evaluate the severity of stroke, in-hospital mortality, major adverse cardiovascular events, and complications associated with a previous HF in these patients.

Methods and results: This cross-sectional study was conducted at 1476 hospitals in the Chinese Stroke Center Alliance. Multivariable logistic regression and propensity score-matched analyses were used to evaluate the association between a history of HF and in-hospital outcomes. Of 836 885 patients with AIS, 1.1% (n=8950) patients had a history of HF. Patients with a history of HF had a higher National Institutes of Health Stroke Scale score at admission (6.0 versus 3.0) than those without a history of HF. Multivariable analysis revealed that a history of HF was associated with an 80% higher risk of all-cause mortality (odds ratio [OR], 1.80 [95% CI, 1.54-2.10]), a 34% higher risk of major adverse cardiovascular events (OR, 1.34 [95% CI, 1.26-1.43]), and a 92% higher risk of complications (OR, 1.92 [95% CI, 1.83-2.02]). Further propensity score matching showed that patients with a history of HF had higher risks of adverse in-hospital outcomes (all-cause mortality: OR, 1.62 [95% CI, 1.30-2.02]; major adverse cardiovascular events: OR, 1.39 [95% CI, 1.26-1.53]; complications: OR, 1.70 [95% CI, 1.58-1.82]).

Conclusions: Patients with AIS and a history of HF have increased risks of severe stroke, in-hospital mortality, major adverse cardiovascular events, and complications. Systematic cardiovascular evaluation and integrated multidisciplinary care for patients with AIS in clinical practice are warranted.