Heart Failure Is Associated With Increased Stroke Severity, In‐Hospital Mortality, Major Adverse Cardiovascular Events, and Complications: Insights From the Chinese Stroke Center Alliance

Background Heart failure (HF) constitutes the source of various damaging pathophysiological mechanisms in acute ischemic stroke (AIS). The effect of a previous HF on the in‐hospital outcomes for patients with AIS still lacks effective research. We aimed to evaluate the severity of stroke, in‐hospital mortality, major adverse cardiovascular events, and complications associated with a previous HF in these patients. Methods and Results This cross‐sectional study was conducted at 1476 hospitals in the Chinese Stroke Center Alliance. Multivariable logistic regression and propensity score–matched analyses were used to evaluate the association between a history of HF and in‐hospital outcomes. Of 836 885 patients with AIS, 1.1% (n=8950) patients had a history of HF. Patients with a history of HF had a higher National Institutes of Health Stroke Scale score at admission (6.0 versus 3.0) than those without a history of HF. Multivariable analysis revealed that a history of HF was associated with an 80% higher risk of all‐cause mortality (odds ratio [OR], 1.80 [95% CI, 1.54–2.10]), a 34% higher risk of major adverse cardiovascular events (OR, 1.34 [95% CI, 1.26–1.43]), and a 92% higher risk of complications (OR, 1.92 [95% CI, 1.83–2.02]). Further propensity score matching showed that patients with a history of HF had higher risks of adverse in‐hospital outcomes (all‐cause mortality: OR, 1.62 [95% CI, 1.30–2.02]; major adverse cardiovascular events: OR, 1.39 [95% CI, 1.26–1.53]; complications: OR, 1.70 [95% CI, 1.58–1.82]). Conclusions Patients with AIS and a history of HF have increased risks of severe stroke, in‐hospital mortality, major adverse cardiovascular events, and complications. Systematic cardiovascular evaluation and integrated multidisciplinary care for patients with AIS in clinical practice are warranted.