Risk of stroke in chronic heart failure patients without atrial fibrillation: Analysis of the Controlled Rosuvastatin in Multinational Trial Heart Failure (CORONA) and the Gruppo Italiano per lo Studio della Sopravvivenza nell'Insufficienza cardiaca-Heart Failure (GISSI-HF) trials

Azmil H. Abdul-Rahim, Ana Cristina Perez, Rachael L. Fulton, Pardeep S. Jhund, Roberto Latini, Gianni Tognoni, John Wikstrand, John Kjekshus, Gregory Y H Lip, Aldo P. Maggioni, Luigi Tavazzi, Kennedy R. Lees, John J V McMurray

Research output: Contribution to journalArticle

Abstract

Background - Our aim was to describe the incidence and predictors of stroke in patients who have heart failure without atrial fibrillation (AF). Methods and Results - We pooled 2 contemporary heart failure trials, the Controlled Rosuvastatin in Multinational Trial Heart Failure (CORONA) and the Gruppo Italiano per lo Studio della Sopravvivenza nell'Insufficienza cardiaca-Heart Failure trial (GISSI-HF). Of the 9585 total patients, 6054 did not have AF. Stroke occurred in 165 patients (4.7%) with AF and in 206 patients (3.4%) without AF (rates 16.8/1000 patient-years and 11.1/1000 patient-years, respectively). Using Cox proportional-hazards models, we identified the following independent predictors of stroke in patients without AF (ranked by χ2 value): age (hazard ratio, 1.34; 95% confidence interval, 1.18-1.63 per 10 years), New York Heart Association class (1.60, 1.21-2.12 class III/IV versus II), diabetes mellitus treated with insulin (1.87, 1.22-2.88), body mass index (0.74, 0.60-0.91 per 5 kg/m2 up to 30), and previous stroke (1.81, 1.19-2.74). N-terminal pro B-type natriuretic peptide (available in 2632 patients) was also an independent predictor of stroke (hazard ratio, 1.31; 1.11-1.57 per log unit) when added to this model. With the use of a risk score formulated from these predictors, we found that patients in the upper third of risk had a rate of stroke that approximated the risk in patients with AF. Conclusions - A small number of demographic and clinical variables identified a subset of patients who have heart failure without AF at a high risk of stroke.

Original languageEnglish
Pages (from-to)1486-1494
Number of pages9
JournalCirculation
Volume131
Issue number17
DOIs
Publication statusPublished - 2015

Keywords

  • Atrial fibrillation
  • Heart failure
  • Risk factors
  • Sinus rhythm
  • Stroke
  • Ventricular ejection fraction

ASJC Scopus subject areas

  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

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