Long-Term Risk of Stroke and Poststroke Outcomes in Patients with Heart Failure: Two Nationwide Studies

OBJECTIVE: To evaluate the long-term risk of stroke and poststroke adverse outcomes in patients with heart failure (HF). METHODS: We used research data from Taiwan's National Health Insurance Program from 2000 to 2005 and identified 20,072 adults aged ≥30 years who were newly diagnosed with HF. Frequency matching based on age and sex was used to select a comparison cohort consisting of 80,288 adults without HF. Events of incident stroke were identified from medical claims during the 2000-2013 follow-up period. The adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of the association of stroke with HF were calculated with a multiple Cox proportional hazard model. Another nested stroke cohort study of 480,604 hospitalized stroke patients determined the adjusted odds ratios (ORs) and 95% CIs for adverse events after stroke in patients with and without HF between 2000 and 2009. RESULTS: Compared with the non-HF cohort, HF patients had an increased risk of stroke (HR 2.32, 95% CI 2.21-2.43), including ischemic stroke and hemorrhagic stroke. The association between HF and stroke was significant in both sexes and in patients in all age groups and with various medical conditions. Previous HF was associated with poststroke mortality (OR 1.40, 95% CI 1.31-1.50), pneumonia (OR 1.33, 95% CI 1.28-1.38), and septicemia (OR 1.30, 95% CI 1.23-1.37). CONCLUSION: HF was associated with a higher risk of stroke, and patients with HF had more complications and greater mortality after stroke.