Purpose This study evaluated the association between ischaemic stroke (IS) and heart failure (HF) in the absence of atrial fibrillation (AF) or atrial flutter (AFL) using a population-based nation-wide cohort database.
Method Newly diagnosed patients with HF without previous stroke and acute myocardial infarction (AMI) were enrolled. Based on the propensity scores matching age, sex and all comorbidities, our studies comprised 12 179 patients with HF and 12 179 patients without HF. Cox proportion hazard regression models and competing-risk regression models were used to evaluate the risk of IS among patients with HF without AF or AFL.
Results In the multivariable analysis, older age (adjusted HR (95% CI)=1.05 (1.04 to 1.05)), male sex (adjusted HR (95% CI)=1.36 (1.24 to 1.50)), diabetes (adjusted HR (95% CI)=2.22 (1.97 to 2.49)) and hypertension (adjusted HR (95% CI)=1.60 (1.41 to 1.82)) were markedly associated with IS in patients with HF. The HF group had a markedly higher risk of IS than did the non-HF group (subdistribution HR (SHR)=1.51, 95% CI: 1.37 to 1.66) and AMI (SHR=3.40, 95% CI: 2.71 to 4.28). Additionally, according to the Kaplan-Meier analysis, patients with HF were at a significantly higher risk of cumulative incidence of IS and AMI than did patients with non-HF (p value of log-rank test <0.001).
Conclusion This study indicated that HF is a strong independent risk factor for IS, even in the absence of AF or AFL. Clinical physicians should investigate IS through routine screening and careful monitoring of patients with HF.
- Ischaemic stroke
- heart failure
- hemorrhagic stroke
- Taiwan National Health Insurance Research Database
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C-SL and C-HK contributed equally.
Contributors All authors have contributed substantially to, and are in agreement with the content of, the manuscript: Conception/Design: Y-LC, C-HK; Provision of study materials: C-HK; Collection and/or assembly of data: Y-LC, C-SL, C-LL, C-HK; Data analysis and interpretation: All authors; Manuscript preparation: All authors; Final approval of manuscript: All authors.
Funding This study is supported by the grants from Tri-Service General Hospital (TSGH-C107-007-007-S02 to C-SL), Ministry of National Defense-Medical Affairs Bureau (MAB-106-082 to C-SL) and Taiwan Ministry of Science and Technology (MOST 106-2314-B-016-038-MY3 to C-SL), Taiwan Ministry of Health and Welfare Clinical Trial Center (MOHW108-TDU-B-212-133004), China Medical University Hospital, Academia Sinica Stroke Biosignature Project (BM10701010021), MOST Clinical Trial Consortium for Stroke (MOST 108-2321-B-039-003-), Tseng-Lien Lin Foundation, Taichung, Taiwan, and Katsuzo and Kiyo Aoshima Memorial Funds, Japan.
Disclaimer The funders had no role in study design, data collection or analysis, decision to publish or preparation of the manuscript. No additional external funding was received for this study.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval The Research Ethics Committee of China Medical University and Hospital in Taiwan approved the study (CMUH104-REC2-115-R4).
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available upon reasonable request.
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