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DURATION OF HEIGHTENED ISCHEMIC STROKE RISK FOLLOWING HOSPITALIZATION FOR ACUTE SYSTOLIC HEART FAILURE
Abstract
Background and Aims
The duration of increased stroke risk after hospitalization for acute systolic heart failure (HF) remains uncertain.
Methods
We performed a retrospective cohort study using claims between 2008 and 2018 from a nationally representative 5% sample of Medicare beneficiaries aged ≥ 66 years old. Patients with claims for ischemic stroke before or during index hospitalization for acute systolic HF were excluded. We used Cox regression models adjusted for demographics, stroke risk factors, and Charlson comorbidities to examine the association between acute systolic HF and ischemic stroke. We stratified the cohort by patients with and without atrial fibrillation prior to or during the hospitalization for acute systolic HF. We used the corresponding survival probabilities to compute the hazard ratio (HR) in each 30-day interval after discharge.
Results
Among 2,077,501 eligible beneficiaries, 94,641 were hospitalized with acute systolic HF and 210,583 for ischemic stroke. After adjusting for demographics, stroke risk factors, and Charlson comorbidities, stroke risk was highest in the first 30 days after discharge from acute systolic HF hospitalization for patients with atrial fibrillation (HR: 2.4; 95% CI, 2.1-2.7) and without atrial fibrillation (HR: 4.6; 95% CI, 4.0-5.3). It remained significantly elevated through 60 days in patients with atrial fibrillation (HR, 1.4; 95% CI, 1.2-1.6) and 330 days in patients without atrial fibrillation (HR: 2.1; 95% CI, 1.7-2.7), and was no longer significantly elevated afterward.
Conclusions
Hospitalization for acute systolic HF is associated with a prolonged increased risk of ischemic stroke. The risk of stroke appears especially prolonged in patients without atrial fibrillation.