Epidemiology of stroke in chronic heart failure patients with normal sinus rhythm: Findings from the DIG stroke sub-study

详细信息    查看全文

• 作者：Marjan Mujib ; Grigorios Giamouzis ; Syed Abbas Agha ; Inmaculada Aban ; Nalini Sathiakumar ; O. James Ekundayo ; Edward Zamrini ; Richard M. Allman ; Javed Butler ; Ali Ahmed
• 关键词：Heart failure ; Stroke ; Epidemiology ; Outcomes ; Race
• 刊名：International Journal of Cardiology
• 出版年：2010
• 出版时间：29 October 2010
• 年：2010
• 卷：144
• 期：3
• 页码：389-393
• 全文大小：178 K

文摘

Background

Little is known about the epidemiology of stroke in chronic systolic and diastolic heart failure (HF) patients in normal sinus rhythm (NSR) receiving angiotensin-converting enzyme (ACE) inhibitors. Because all HF patients in the Digitalis Investigation Group (DIG) trial (N = 7788) were in NSR and nearly all were receiving ACE inhibitors, a survey-based stroke-sub-study was conducted but its findings have never been published.

Methods

DIG investigators confirmed a total 222 cases of stroke of which 144 had neurological deficit ≥ 24 h. We used logistic regression models to determine predictors of incident stroke among all 7788 patients and predictors of neurological deficit ≥ 24 h and all-cause mortality among 222 stroke patients.

Results

Age ≥ 65 years (adjusted odds ratio {AOR}, 1.36; 95 % confidence interval {CI}, 1.02–1.80; P = 0.035), nonwhite race (AOR, 0.65; 95 % CI, 0.42–0.99; P = 0.047), hypertension (AOR, 1.46; 95 % CI, 1.11–1.94; P = 0.008), diabetes mellitus (AOR, 1.37; 95 % CI, 1.03–1.82; P = 0.030), and cardiomegaly (AOR, 1.39; 95 % CI, 1.03–1.86; P = 0.030) were independent predictors of stroke. However, among those with stroke, nonwhites had higher odds of neurological deficits ≥ 24 h (AOR, 2.86; 95 % CI, 1.01–8.07; P = 0.047) and death (AOR, 3.28; 95 % CI, 1.30–8.30; P = 0.012).

Conclusion

Older age, hypertension, diabetes and cardiomegaly were associated with increased incidence of stroke among HF patients with NSR receiving ACE inhibitors. The association of race and stroke, however, was complex. While nonwhite race was associated with decreased risk of stroke, among those with stroke, nonwhite race was associated with increased stroke severity and mortality.