Increased Risk of Heart Failure Among Stroke Survivors: A Nationwide Cohort Study

초록

Highlights What are the main findings? Stroke survivors, regardless of stroke subtypes, were at significantly greater long-term risk for heart failure than non-stroke controls. In particular, stroke survivors with severe disability showed the highest risk of heart failure. What are implications of the main findings? Clinicians need to be aware of the importance of heart failure as a long-term consequence of stroke. Interventions and targeted prevention strategies addressing modifiable risk factors for heart failure are necessary.Highlights What are the main findings? Stroke survivors, regardless of stroke subtypes, were at significantly greater long-term risk for heart failure than non-stroke controls. In particular, stroke survivors with severe disability showed the highest risk of heart failure. What are implications of the main findings? Clinicians need to be aware of the importance of heart failure as a long-term consequence of stroke. Interventions and targeted prevention strategies addressing modifiable risk factors for heart failure are necessary.Abstract Background/Objectives: Stroke-induced cardiac damage may lead to lifelong cardiac problems, such as heart failure (HF). We aimed to compare the incidence of HF between stroke survivors and the general non-stroke population. Methods: We performed a population-based study of individuals in the Korean National Health Insurance Service database. We included 220,231 stroke survivors between 2010 and 2018 and 1:1 age- and sex-matched non-stroke controls. The study outcome was HF and the cohort was followed up until 2019. Cox hazards models were used to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for HF risk. Results: At baseline, stroke survivors had a substantially higher comorbidity burden than matched controls (Charlson Comorbidity Index 4.1 vs. 1.6), with higher rates of hypertension, type 2 diabetes, and dyslipidemia, and were more likely to be current smokers and heavy drinkers. Stroke survivors showed a higher risk for HF (aHR 1.69, 95% CI 1.65-1.73) compared to controls. The risks were further increased with disability, as demonstrated in comparison of those with mild disability (aHR 1.78, 95% CI 1.70-1.87) and those with severe disability (aHR 2.22, 95% CI 2.10-2.36). Before applying the 1-year lag period, the association appeared more prominent among hemorrhagic stroke survivors than ischemic stroke survivors. However, following the 1-year lag period, the HF risk was similar between stroke subtypes (hemorrhagic stroke with disability: aHR 1.77, 95% CI 1.62-1.93; ischemic stroke with disability: aHR 1.71, 95% CI 1.63-1.80). Propensity score matching incorporating all baseline characteristics confirmed the robustness of the primary findings. Conclusions: Stroke survivors, who had a greater burden of cardiovascular risk factors, were at significantly greater risk for incident HF compared with age- and sex-matched non-stroke controls, particularly those with disability. Clinicians need to be aware of the importance of HF in stroke survivors who have multiple comorbidities and disability.

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