Tiberiu A Pana1, Adrian D Wood1, Jesus A Perdomo-Lampignano1, Somsak Tiamkao2,3, Allan B Clark4, Kannikar Kongbunkiat2,5, Joao H Bettencourt-Silva6, Kittisak Sawanyawisuth5, Narongrit Kasemsap3,5, Mamas A Mamas7, Phyo K Myint1. 1. Ageing Clinical and Experimental Research Team, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK. 2. Neurology Division, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand. 3. North-Eastern Stroke Research Group, Khon Kaen University, Khon Kaen, Thailand. 4. Norwich Medical School, University of East Anglia, Norwich, UK. 5. Ambulatory Medicine Division, Department of Meidicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand. 6. Clinical informatics, Department of Medicine, University of Cambridge, Cambridge, UK. 7. Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, Stoke-on-Trent, UK.
Abstract
OBJECTIVE: We aimed to examine the impact of heart failure (HF) on stroke mortality (in-hospital and postdischarge) and recurrence in a national stroke cohort from Thailand. METHODS: We used a large, insurance-based database including all stroke admissions in the public health sector in Thailand between 2004 and 2015. Logistic and Royston-Parmar regressions were used to quantify the effect of HF on in-hospital and long-term outcomes, respectively. All models were adjusted for age, sex and comorbidities and stratified by stroke type: acute ischaemic stroke (AIS) or intracerebral haemorrhage (ICH). Multistate models were constructed using flexible survival techniques to predict the impact of HF on the disease course of a patient with stroke (baseline-[recurrence]-death). Only first-ever cases of AIS or ICH were included in the multistate analysis. RESULTS: 608 890 patients (mean age 64.29±13.72 years, 55.07% men) were hospitalised (370 527 AIS, 173 236 ICH and 65 127 undetermined pathology). There were 398 663 patients with first-ever AIS and ICH. Patients were followed up for a median (95% CI) of 4.47 years (4.45 to 4.49). HF was associated with an increase in postdischarge mortality in AIS (HR [99% CI] 1.69 [1.64 to 1.74]) and ICH (2.59 [2.07 to 3.26]). HF was not associated with AIS recurrence, while ICH recurrence was only significantly increased within the first 3 years after discharge (1.79 [1.18 to 2.73]). CONCLUSIONS: HF increases the risk of mortality in both AIS and ICH. We are the first to report on high-risk periods of stroke recurrence in patients with HF with ICH. Specific targeted risk reduction strategies may have significant clinical impact for mortality and recurrence in stroke.
OBJECTIVE: We aimed to examine the impact of heart failure (HF) on stroke mortality (in-hospital and postdischarge) and recurrence in a national stroke cohort from Thailand. METHODS: We used a large, insurance-based database including all stroke admissions in the public health sector in Thailand between 2004 and 2015. Logistic and Royston-Parmar regressions were used to quantify the effect of HF on in-hospital and long-term outcomes, respectively. All models were adjusted for age, sex and comorbidities and stratified by stroke type: acute ischaemic stroke (AIS) or intracerebral haemorrhage (ICH). Multistate models were constructed using flexible survival techniques to predict the impact of HF on the disease course of a patient with stroke (baseline-[recurrence]-death). Only first-ever cases of AIS or ICH were included in the multistate analysis. RESULTS: 608 890 patients (mean age 64.29±13.72 years, 55.07% men) were hospitalised (370 527 AIS, 173 236 ICH and 65 127 undetermined pathology). There were 398 663 patients with first-ever AIS and ICH. Patients were followed up for a median (95% CI) of 4.47 years (4.45 to 4.49). HF was associated with an increase in postdischarge mortality in AIS (HR [99% CI] 1.69 [1.64 to 1.74]) and ICH (2.59 [2.07 to 3.26]). HF was not associated with AIS recurrence, while ICH recurrence was only significantly increased within the first 3 years after discharge (1.79 [1.18 to 2.73]). CONCLUSIONS: HF increases the risk of mortality in both AIS and ICH. We are the first to report on high-risk periods of stroke recurrence in patients with HF with ICH. Specific targeted risk reduction strategies may have significant clinical impact for mortality and recurrence in stroke.
Authors: David J McLernon; Phyo K Myint; Weronika A Szlachetka; Tiberiu A Pana; Mamas A Mamas; Joao H Bettencourt-Silva; Anthony K Metcalf; John F Potter Journal: Acta Neurol Belg Date: 2021-08-18 Impact factor: 2.471
Authors: Tiberiu A Pana; Dana K Dawson; Mohamed O Mohamed; Fiona Murray; David L Fischman; Michael P Savage; Mamas A Mamas; Phyo K Myint Journal: J Am Heart Assoc Date: 2021-03-08 Impact factor: 5.501