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Stroke recurrence risk high in patients with comorbid AF or HF

10 Jun 2019

Atrial fibrillation (AF) carries an excess risk of stroke recurrence independent of comorbidity with and heart failure (HF), while HF without AF also poses a significant risk of recurrence, a study has shown.

The study included 10,816 hospitalized patients (mean age, 77.9 years; 49 percent male) with acute ischaemic stroke followed up for a median of 5.5 years for mortality and 3.7 years for stroke recurrence.

Of the patients, 2,605 (24.1 percent) had AF only, 611 (5.7 percent) had HF only, 932 (8.6 percent) had both and 6,668 (61.7 percent) had neither comorbidity. Patients with both AF and HF were the oldest (mean, 83.5 years) and had the highest in-hospital mortality. Only 30 (4.9 percent) of the patients with HF but not AF received anticoagulants at discharge.

The odds of in-hospital mortality were high in patients with AF only (odds ratio [OR], 1.24, 95 percent CI, 1.07–1.43), HF only (OR, 1.40, 1.10–1.79) and their combination (OR, 2.23, 1.83–2.72). All three exposure groups had an increased hospital length-of-stay, while only AF predicted increased disability (OR, 1.36, 1.12–1.64).

Furthermore, long-term mortality was high in the AF group (hazard ratio [HR], 1.45, 1.33–1.59), HF group (HR, 2.07, 1.83–2.36) and their combination (HR, 2.20, 1.96–2.46). All three groups were also associated with increased risk of recurrent stroke, with respective HRs of 1.50 (1.26–1.78), 1.33 (1.01–1.75) and 1.62 (1.28–2.07).

Overall, the study provides real-world prognostic information for acute ischaemic stroke patients with AF, HF or both. In light of the excess risk of recurrent stroke associated with AF independent of comorbid HF as well as with HF in isolation, researchers highlighted the need for further evaluation of anticoagulation strategies in stroke patients with HF but without AF.

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