Clinical InvestigationsNationwide Frequency and Association of Heart Failure on Stroke Outcomes in the United States
Section snippets
Data Source
We extracted data for the study from the 1995 and 2005 National Inpatient Sample (NIS) database. The NIS, which is maintained as part of the Healthcare Cost and Utilization Project (HCUP) of the Agency for Healthcare Quality and Research, is the largest all-payer inpatient care database that is publicly available in the United States (US). From 1988 to 2005, NIS captured discharge-level information on primary and secondary diagnoses and procedures, discharge vital signs, and demographics on 6
Results
We identified 632,225 stroke patients in 1995 and 555,915 in 2005. The hospitalization rates for stroke patients (per 100,000) in 1995 and 2005 were 333.4 and 258.9, respectively. After age standardization to the 2005 estimated census population, the hospitalization rate increased to 348.6 for stroke patients in 1995. The percentage of stroke patients with HF was 10.8% of all stroke admissions in 1995 and 12.3% in 2005. Demographic characteristics, procedures, co-morbidities and discharge
Discussion
This study presents the first nationwide report of the association of HF with outcomes in acute ischemic stroke in the US. In our study, the in-hospital mortality rates for stroke patients with HF were 2.5 and 2.2 times higher in 1995 and 2005, respectively, compared with stroke patients without HF.
As reported by Sharma et al.4, pre-existing HF has the highest adverse influence on stroke mortality, and it is independent of other known factors. In the Framingham Study19, stroke patients with
Conclusions
The results of our study suggest an association exists between co-existing HF and mortality in stroke patients. Stroke patients with HF appear to have a higher mortality rate, longer LOS, and higher hospitalization cost compared with those without HF. The mechanism of the higher stroke mortality and morbidity in patients with HF requires further investigation to identify modifiable factors and to determine better treatments.
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