Insights in Pediatric Cardiology

CHF and various risk factors

Introduction: Congestive heart failure (CHF) is a relatively common condition in stroke patients. Limited information is known regarding CHF in patients with an acute ischemic stroke (AIS). Objective: We evaluated clinical characteristics, predisposing factors, and outcomes in stroke patients with history of CHF. Methods: We prospectively included AIS patients admitted to the institutions participating in the Registry of the Canadian Stroke Network (RCSN) between 2014 and 2019. History of chronic congestive heart failure (CHF) determined from medical records, physical examination and investigations. Primary outcome was death or disability at discharge (modified Rankin scale equal to or greater than 3). Secondary outcomes included admission ICU, disposition, length of hospital stay, death at 3 months and at 1 year and 30 day hospital readmissions. Logistic regression and survival analyses were performed to determine the association of risk factors with the outcomes of interest. Results: Among 12686 patients with AIS, CHF was found in 1152 (9.1%) of patients. Mean age was 78.5±11 years. CHF patients were more likely to have hypertension, diabetes mellitus, hyperlipidemia, coronary artery disease, atrial fibrillation, vulvular heart disease and peripheral vascular disease. CHF more likely presented with a severe stroke (25.8% vs 14.1%, p<0.0001) and cardioembolic stroke subtype (42.2% vs 21.3%, p<0.0001). CHF was associated with higher risk of death at 30-days (24.2% vs 11.2%; p<0.0001) and at 1-year (44% vs 20.6;p<0.0001) and disability at discharge (70.3% vs 56%; p<0.0001). Mean length of stay was longer in stroke patients with CHF (15.51±23.91 vs 12.65±19.76 ; p=0.013). In the multivariate analysis, CHF (OR 1.18; 95%CI 1.01- 1.37) was an independent predictor of death and disability after adjusting age, stroke severity, and other comorbid conditions. Conclusions: In this large cohort study, CHF occurred in 9.1% of AIS patients. Stroke patients with CHF had poorer outcomes and longer hospitalization. Furthermore, after adjusting age, stroke severity and comorbidity, CHF was an independent predictor of death and disability. Still need fund for more intensive research.

Author(s):

 

Monirul Haque

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