中风与心力衰竭：临床特征、医疗可及性及预后

Stroke and Heart Failure: Clinical Features, Access to Care, and Outcomes.

作者信息

Pongmoragot Jitphapa, Lee Douglas S, Park Tai Hwan, Fang Jiming, Austin Peter C, Saposnik Gustavo

机构信息

Stroke Outcomes Research Center, Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.

Peter Munk Cardiac Centre, Joint Department of Medical Imaging, Institute for Clinical Evaluative Science, IHPME, University Health Network, Toronto, Ontario, Canada.

出版信息

J Stroke Cerebrovasc Dis. 2016 May;25(5):1048-1056. doi: 10.1016/j.jstrokecerebrovasdis.2016.01.013. Epub 2016 Feb 4.

DOI:10.1016/j.jstrokecerebrovasdis.2016.01.013

PMID:26853141

Abstract

BACKGROUND AND OBJECTIVES

Limited information is known regarding acute ischemic stroke (AIS) and heart failure (HF). The aim of the study was to evaluate clinical characteristics, predisposing factors, and outcomes in AIS with HF.

METHODS

We included AIS patients admitted to the institutions participating in the Registry of the Canadian Stroke Network. HF was defined as history of pre-existing HF or pulmonary edema present at the time of arrival. The primary outcome was death or disability at discharge (modified Rankin Scale score >3). Secondary outcomes included disposition, death at 3 months and at 1 year, and 30-day hospital readmissions.

RESULTS

Among 12,396 patients, HF was found in 1124 (9.1%) patients. HF was associated with higher risk of death at 30 days (24.5% versus 11.2%, P < .0001), at 1 year (44.3% versus 20.6, P < .0001), and disability at discharge (70.4% versus 56%, P < .0001). In the multivariable analysis, HF was an independent predictor of death and disability (odds ratio 1.18, 95% confidence interval [CI] 1.01-1.37), death at 30 days (hazard ratio [HR] 1.22, 95% CI 1.05-1.41), and hospital readmissions (HR 1.32, 95% CI 1.05-1.65) at 30 days. The results were unaltered when adjusting for pneumonia with the exception of death or disability at discharge.

CONCLUSIONS

In this large cohort study, HF was observed in 9.1% of AIS patients. HF is an independent predictor of death and disability and hospital readmissions after stroke at 30 days.

摘要

背景与目的

关于急性缺血性卒中（AIS）和心力衰竭（HF）的信息有限。本研究的目的是评估合并HF的AIS患者的临床特征、诱发因素及预后。

方法

我们纳入了参与加拿大卒中网络登记处的机构收治的AIS患者。HF定义为既往有HF病史或入院时存在肺水肿。主要结局是出院时死亡或残疾（改良Rankin量表评分>3）。次要结局包括出院情况、3个月和1年时的死亡情况以及30天内再次入院情况。

结果

在12396例患者中，1124例（9.1%）患者存在HF。HF与30天时更高的死亡风险相关（24.5%对11.2%，P<0.0001），1年时（44.3%对20.6%，P<0.0001），以及出院时的残疾（70.4%对56%，P<0.0001）。在多变量分析中，HF是死亡和残疾的独立预测因素（比值比1.18，95%置信区间[CI]1.01 - 1.37），30天时的死亡（风险比[HR]1.22，95%CI 1.05 - 1.41），以及30天内再次入院（HR 1.32，95%CI 1.05 - 1.65）。除出院时的死亡或残疾外，校正肺炎后结果未改变。