Risk Factors for Acute Heart Failure and Impact on In-Hospital Mortality after Stroke

Abstract

Background: In the acute phase of stroke, some patients develop cardiac events. It could be fatal in their clinical courses. We aimed to investigate acute heart failure after stroke onset and stratify the patients by establishing a predictive model.

Methods: This single-center, observational study included stroke patients diagnosed at the Department of Neurology and Neurosurgery from January 2013 to December 2014. Baseline characteristics and clinical findings on admission were analyzed for acute heart failure after stroke. We assessed risk factors using multivariable logistic regression, and set a risk score to evaluate the association with poor outcomes.

Results: Of 532 stroke patients, 27 (5%) developed acute heart failure within the 7 days after admission. We identified 4 risk factors for acute heart failure after stroke: atrial fibrillation (odds ratio [OR], 5.9; 95% confidence interval [CI], 2.5-14.0; P < .001), history of cardiac disease (OR, 3.6; 95% CI, 1.3-9.1; P = .01), Glasgow Coma Scale score ≤ 8 (OR, 4.5; 95% CI, 1.7-12.0; P = .003), and serum albumin < 35 g/L (OR, 3.4; 95% CI, 1.4-8.4; P = .008). Furthermore in-hospital mortality rate was higher (37% [n = 10/27] versus 9.9% [n = 50/505], P = .001) in patients with poststroke heart failure. Higher predictive scores were associated with increased mortality.

Conclusions: Acute heart failure can develop in the early phase of stroke and lead to poor outcomes. It is foreseeable and preventable by stratifying and monitoring high-risk patients.

Keywords: Stroke; heart failure; outcome; risk factors.