‘Stroke-heart syndrome’ increases 5-year risk for CV events, death
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New-onset CV complications after ischemic stroke predicts worse 5-year prognosis for major adverse CV events, including death, according to new research published in Stroke.
In an analysis of more than 360,000 patient medical records, researchers also found that patients with a newly diagnosed CV complication within 4 weeks of an ischemic stroke were 50% more likely to experience recurrent stroke at 5-year follow-up.
“We know heart disease and stroke share similar risk factors, and there’s a two-way relationship between the risk of stroke and heart disease. For example, heart conditions such as atrial fibrillation increase the risk of stroke, and stroke also increases the risk of heart conditions,” Benjamin J.R. Buckley, PhD, a postdoctoral research fellow in preventive cardiology at the Liverpool Centre for Cardiovascular Science, University of Liverpool, U.K., said in a press release. “We wanted to know how common newly diagnosed heart complications are after a stroke and, importantly, whether stroke-heart syndrome is associated with increased risk of long-term major adverse events.”
In a retrospective study, Buckley and colleagues analyzed electronic medical records data from 365,383 patients with ischemic stroke and 5 years of follow-up, using data from 53 participating health care organizations. Researchers propensity score-matched patients with who were diagnosed with new-onset CV complications (HF, severe ventricular arrhythmia, AF, ischemic heart disease, Takotsubo syndrome) within 4 weeks of the incident ischemic stroke with patients who had a stroke but were not diagnosed with new-onset complications (controls), based on age, sex, race, comorbidities and CV care.
Within the cohort, 11.1% developed ACS; 8.8% developed AF/flutter; 6.4% developed HF; 1.2% developed severe ventricular arrythmias; and 0.1% developed Takotsubo syndrome within 4 weeks of the incident stroke.
After propensity score matching, odds for 5-year all-cause mortality were higher among patients with stroke who developed ACS (OR = 1.49; 95% CI, 1.44-1.54), AF/flutter (OR = 1.45; 95% CI, 1.4-1.5), HF (OR = 1.83; 95% CI, 1.76-1.91), and severe ventricular arrhythmias (OR = 2.08; 95% CI, 1.9-2.29) compared with controls.
Odds for 5-year rehospitalization and acute MI were also higher for patients with stroke diagnosed with new-onset CV complications. Takotsubo syndrome was associated with significantly higher odds for 5-year composite major adverse CV events, defined as death, hospitalization, recurrent stroke and acute MI (OR = 1.89; 95% CI, 1.29-2.77). AF/flutter was the only new-onset cardiac complication associated with significantly higher odds for recurrent ischemic stroke at 5 years (OR = 1.1; 95% CI, 1.07-1.14).
“Most notably, distinguishing stroke-heart syndrome from (otherwise unknown) concomitant or preceding cardiovascular complications is challenging, and reverse causation may have impacted the results of this study,” the researchers wrote. “For example, whether the new-onset cardiovascular complications, diagnosed after ischemic stroke, were caused by stroke, or contributed to the stroke is unclear. Indeed, prospective research is needed to infer causation, albeit a challenging endeavor in a stroke population.”
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