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Stroke-Heart Syndrome: Incidence and Clinical Outcomes of Cardiac Complications Following Stroke.

Buckley, BJR, Harrison, SL, Hill, A, Underhill, P, Lane, DA and Lip, GYH (2022) Stroke-Heart Syndrome: Incidence and Clinical Outcomes of Cardiac Complications Following Stroke. Stroke, 53 (5). pp. 1759-1763. ISSN 0039-2499

Stroke-Heart Syndrome Incidence and clinical outcomes of cardiac complications following stroke.pdf - Accepted Version

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Background: The risk of major adverse cardiovascular events is substantially increased following a stroke. Although exercise-based cardiac rehabilitation has been shown to improve prognosis following cardiac events, it is not part of routine care for people following a stroke. We, therefore, investigated the association between cardiac rehabilitation and major adverse cardiovascular events for people following a stroke. Following a stroke, individuals have an increased risk of new-onset cardiovascular complications. However, the incidence and long-term clinical consequence of newly diagnosed cardiovascular complications following a stroke is unclear. The aim of the present study was to investigate the incidence and long-term clinical outcomes of newly diagnosed cardiovascular complications following incident ischemic stroke.
Methods: A retrospective cohort study was conducted using anonymized electronic medical records from 53 participating health care organizations. Patients with incident ischemic stroke aged ≥18 years with 5 years of follow-up were included. Patients who were diagnosed with new-onset cardiovascular complications (heart failure, severe ventricular arrhythmia, atrial fibrillation, ischemic heart disease, Takotsubo syndrome) within 4-weeks (exposure) of incident ischemic stroke were 1:1 propensity score-matched (age, sex, ethnicity, comorbidities, cardiovascular care) with ischemic stroke patients who were not diagnosed with a new-onset cardiovascular complication (control). Logistic regression models produced odds ratios (OR) with 95% CIs for 5-year incidence of all-cause mortality, recurrent stroke, hospitalization, and acute myocardial infarction.
Results: Of 365 383 patients with stroke with 5-year follow-up: 11.1% developed acute coronary syndrome; 8.8% atrial fibrillation/flutter; 6.4% heart failure; 1.2% severe ventricular arrythmias; and 0.1% Takotsubo syndrome within 4 weeks of incident ischemic stroke. Following propensity score matching, odds of 5-year all-cause mortality were significantly higher in stroke patients with acute coronary syndrome (odds ratio, 1.49 [95% CI, 1.44–1.54]), atrial fibrillation/flutter (1.45 [1.40–1.50]), heart failure (1.83 [1.76–1.91]), and severe ventricular arrhythmias (2.08 [1.90–2.29]), compared with matched controls. Odds of 5-year rehospitalization and acute myocardial infarction were also significantly higher for patients with stroke diagnosed with new-onset cardiovascular complications. Takotsubo syndrome was associated with significantly higher odds of 5-year composite major adverse cardiovascular events (1.89 [1.29–2.77]). Atrial fibrillation/flutter was the only new-onset cardiac complication associated with significantly higher odds of recurrent ischemic stroke at 5 years (1.10 [1.07–1.14]).
Conclusions: New-onset cardiovascular complications diagnosed following an ischemic stroke are very common and associate with significantly worse 5-year prognosis in terms of major adverse cardiovascular events. People with stroke and newly diagnosed cardiovascular complications had >50% prevalence of recurrent stroke at 5 years.

Item Type: Article
Uncontrolled Keywords: Humans; Atrial Fibrillation; Myocardial Infarction; Incidence; Risk Factors; Retrospective Studies; Adolescent; Adult; Heart Failure; Stroke; Acute Coronary Syndrome; Takotsubo Cardiomyopathy; Ischemic Stroke; acute coronary syndrome; arrythmias; atrial fibrillation; cerebrovascular disorders; heart failure; ischemic stroke; secondary prevention; Acute Coronary Syndrome; Adolescent; Adult; Atrial Fibrillation; Heart Failure; Humans; Incidence; Ischemic Stroke; Myocardial Infarction; Retrospective Studies; Risk Factors; Stroke; Takotsubo Cardiomyopathy; 1102 Cardiorespiratory Medicine and Haematology; 1103 Clinical Sciences; 1109 Neurosciences; Neurology & Neurosurgery
Subjects: R Medicine > RC Internal medicine > RC1200 Sports Medicine
Divisions: Sport & Exercise Sciences
Publisher: Lippincott, Williams & Wilkins
SWORD Depositor: A Symplectic
Date Deposited: 17 May 2022 11:46
Last Modified: 30 Sep 2022 00:50
DOI or ID number: 10.1161/strokeaha.121.037316
URI: https://researchonline.ljmu.ac.uk/id/eprint/16817
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