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

Pubmed ID: 19439379

Pubmed Central ID: PMC2952701

Journal: International journal of cardiology

Publication Date: Oct. 29, 2010

Affiliation: University of Alabama at Birmingham, 1530 3rd Avenue South, CH-19, Ste-219, Birmingham, AL 35294-2041, USA.

MeSH Terms: Humans, Male, Female, Aged, Odds Ratio, Risk Factors, Hypertension, Diabetes Complications, Chronic Disease, Heart Failure, Confidence Intervals, Alabama, Angiotensin-Converting Enzyme Inhibitors, Incidence, Stroke, Cardiomegaly, Health Surveys, Heart Rate

Grants: R01 HL085561, 1-R01-HL085561-01, P30 AG31054-01, UL1 TR000454, P30 AG031054

Authors: Ekundayo OJ, Aban I, Ahmed A, Mujib M, Giamouzis G, Butler J, Allman RM, Agha SA, Sathiakumar N, Zamrini E

Cite As: Mujib M, Giamouzis G, Agha SA, Aban I, Sathiakumar N, Ekundayo OJ, Zamrini E, Allman RM, Butler J, Ahmed A. Epidemiology of stroke in chronic heart failure patients with normal sinus rhythm: findings from the DIG stroke sub-study. Int J Cardiol 2010 Oct 29;144(3):389-93. Epub 2009 May 12.

Studies:

Abstract

BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSION: 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.