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

Buckley, Benjamin JR ORCID: 0000-0002-1479-8872, Harrison, Stephanie L ORCID: 0000-0002-8846-0946, Hill, Andrew, Underhill, Paula, Lane, Deirdre A ORCID: 0000-0002-5604-9378 and Lip, Gregory YH ORCID: 0000-0002-7566-1626 (2022) Stroke-Heart Syndrome: Incidence and Clinical Outcomes of Cardiac Complications Following Stroke. STROKE, 53 (5). pp. 1759-1763.

Text STROKE:2021:037316 R2 Manuscript Clean_23.2.22.docx - Author Accepted Manuscript Download (52kB)

Abstract

<h4>Background</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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]).<h4>Conclusions</h4>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:	acute coronary syndrome, arrythmias, atrial fibrillation, cerebrovascular disorders, heart failure, ischemic stroke, secondary prevention
Divisions:	Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences
Depositing User:	Symplectic Admin
Date Deposited:	12 Apr 2022 14:53
Last Modified:	18 Jan 2023 21:05
DOI:	10.1161/STROKEAHA.121.037316
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3152704