Division of Neurocritical Care Weill Cornell Medicine New York NY USA.
Weill Cornell Medicine - Qatar Doha Qatar.
J Am Heart Assoc. 2023 Mar 21;12(6):e027179. doi: 10.1161/JAHA.122.027179. Epub 2023 Mar 16.
Background The duration and magnitude of increased stroke risk after a hospitalization for acute systolic heart failure (HF) remains uncertain. Methods and Results The authors performed a retrospective cohort study using claims (2008-2018) from a nationally representative 5% sample of Medicare beneficiaries aged ≥66 years. Cox regression models were fitted separately for the groups with and without acute systolic HF to examine its association with the incidence of ischemic stroke after adjustment for demographics, stroke risk factors, and Charlson comorbidities. Corresponding survival probabilities were used to compute the hazard ratio (HR) in each 30-day interval after discharge. The authors stratified patients by the presence of atrial fibrillation (AF) before or during the hospitalization for acute systolic HF. Among 2 077 501 eligible beneficiaries, 94 641 were hospitalized with acute systolic HF. After adjusting for demographics, stroke risk factors, and Charlson comorbidities, the risk of ischemic stroke was highest in the first 30 days after discharge from an acute systolic HF hospitalization for patients with AF (HR, 2.4 [95% CI, 2.1-2.7]) and without AF (HR, 4.6 [95% CI, 4.0-5.3]). The risk of stroke remained elevated for 60 days in patients with AF (HR, 1.4 [95% CI, 1.2-1.6]) and was not significantly elevated afterward. The risk of stroke remained significantly elevated through 330 days in patients without AF (HR, 2.1 [95% CI, 1.7-2.7]) and was no longer significantly elevated afterward. Conclusions A hospitalization for acute systolic HF is associated with an increased risk of ischemic stroke up to 330 days in patients without concomitant AF.
急性收缩性心力衰竭（HF）住院后中风风险的持续时间和程度仍不确定。
作者使用来自全国代表性的 Medicare 受益人的 5%样本（年龄≥66 岁）的索赔数据（2008-2018 年）进行了回顾性队列研究。为了检查急性收缩性 HF 与其在调整人口统计学、中风危险因素和 Charlson 合并症后发生缺血性中风的相关性，分别为有和没有急性收缩性 HF 的组拟合 Cox 回归模型。使用相应的生存概率计算每个 30 天间隔的危险比（HR）。作者按是否在急性收缩性 HF 住院期间存在心房颤动（AF）对患者进行分层。在 2077501 名合格的受益人中，有 94641 名因急性收缩性 HF 住院。在调整人口统计学、中风危险因素和 Charlson 合并症后，患有 AF（HR，2.4[95%CI，2.1-2.7]）和没有 AF（HR，4.6[95%CI，4.0-5.3]）的患者在急性收缩性 HF 出院后的前 30 天中风风险最高。患有 AF 的患者中风风险在 60 天内仍然升高（HR，1.4[95%CI，1.2-1.6]），之后不再显著升高。没有 AF 的患者中风风险在 330 天内仍然显著升高（HR，2.1[95%CI，1.7-2.7]），之后不再显著升高。
急性收缩性 HF 住院与无合并 AF 的患者缺血性中风风险增加相关，可高达 330 天。
