Long-Term Risk of Stroke and Poststroke Outcomes in Patients with Heart Failure: Two Nationwide Studies

Ying-Hsuan Tai,1,2,* Chuen-Chau Chang,2– 4 Chun-Chieh Yeh,5,6 Li-Chin Sung,7 Chaur-Jong Hu,8 Yih-Giun Cherng,1,2 Ta-Liang Chen,2,4,9,* Chien-Chang Liao2– 4,10,11 1Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; 2Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; 3Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan; 4Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan; 5Department of Surgery, China Medical University Hospital, Taichung, Taiwan; 6Department of Surgery, University of Illinois, Chicago, IL, USA; 7Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; 8Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; 9Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; 10Research Center of Big Data and Meta-Analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; 11School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan*These authors contributed equally to this workCorrespondence: Chien-Chang LiaoDepartment of Anesthesiology, Taipei Medical University Hospital, 252 Wuxing Street, Taipei 110, TaiwanEmail jacky48863027@yahoo.com.twYih-Giun CherngDepartment of Anesthesiology, Shuang Ho Hospital, New Taipei City, TaiwanEmail stainless@s.tmu.edu.twObjective: To evaluate the long-term risk of stroke and poststroke adverse outcomes in patients with heart failure (HF).Methods: We used research data from Taiwan’s National Health Insurance Program from 2000 to 2005 and identified 20,072 adults aged ≥ 30 years who were newly diagnosed with HF. Frequency matching based on age and sex was used to select a comparison cohort consisting of 80,288 adults without HF. Events of incident stroke were identified from medical claims during the 2000– 2013 follow-up period. The adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of the association of stroke with HF were calculated with a multiple Cox proportional hazard model. Another nested stroke cohort study of 480,604 hospitalized stroke patients determined the adjusted odds ratios (ORs) and 95% CIs for adverse events after stroke in patients with and without HF between 2000 and 2009.Results: Compared with the non-HF cohort, HF patients had an increased risk of stroke (HR 2.32, 95% CI 2.21– 2.43), including ischemic stroke and hemorrhagic stroke. The association between HF and stroke was significant in both sexes and in patients in all age groups and with various medical conditions. Previous HF was associated with poststroke mortality (OR 1.40, 95% CI 1.31– 1.50), pneumonia (OR 1.33, 95% CI 1.28– 1.38), and septicemia (OR 1.30, 95% CI 1.23– 1.37).Conclusion: HF was associated with a higher risk of stroke, and patients with HF had more complications and greater mortality after stroke.Keywords: heart failure, adverse outcome, risk, stroke