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

University of Alabama at Birmingham, 1530 3rd Avenue South, CH-19, Ste-219, Birmingham, AL 35294-2041, USA.
International journal of cardiology (Impact Factor: 4.04). 05/2009; 144(3):389-93. DOI: 10.1016/j.ijcard.2009.04.035
Source: PubMed


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.
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.
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).
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.


Available from: Marjan Mujib
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    • "Over the last decade, the annual number of hospitalizations has increased from 800,000 to over a million for HF as a primary diagnosis and from 2.4 to 3.6 million for HF as a primary or secondary diagnosis [1]. Approximately 50% of HF patients are rehospitalized within 6 months of discharge and with the aging of the population this trend will continue to rise [2] [3]. Understanding the epidemiology and pathophysiology of the syndrome [4], identifying the predictors and their strength of association with outcomes, and cost-effectively using the available diagnostic modalities are essential in order to devise effective preventive interventions and implement novel therapeutic approaches to curb this epidemic [5] [6] [7] [8]. "
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