Advances in Neurocardiology: Focus on Atrial Fibrillation

Sposato, Luciano A.; Gurol, M. Edip

doi:10.1161/strokeaha.121.033970

Stroke

2021

DOI: 10.1161/strokeaha.121.033970

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Advances in Neurocardiology: Focus on Atrial Fibrillation

Luciano A. Sposato

M. Edip Gurol

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Cited by 6 publications

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“…An official neurocardiology working group (World Stroke Organization Brain & Heart Task Force) was recently established, which highlights the need and commitment for multidisciplinary clinical and research collaborations to improve care and outcomes for conditions, such as the stroke-heart syndrome. 5 Although some studies have demonstrated that the stroke-heart syndrome associates with unfavorable short-term (acute) prognosis, long-term consequences, including secondary cardiac events and mortality, have not been previously described. Therefore, the aim of the present study was to investigate the incidence and long-term clinical outcomes of new-onset cardiovascular complications diagnosed following incident ischemic stroke.…”

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Stroke-Heart Syndrome: Incidence and Clinical Outcomes of Cardiac Complications Following Stroke

Buckley

Harrison

Hill

et al. 2022

Stroke

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Background: The risk of major adverse cardiovascular events is substantially increased following a stroke. Although exercise-based cardiac rehabilitation has been shown to improve prognosis following cardiac events, it is not part of routine care for people following a stroke. We, therefore, investigated the association between cardiac rehabilitation and major adverse cardiovascular events for people following a stroke. Following a stroke, individuals have an increased risk of new-onset cardiovascular complications. However, the incidence and long-term clinical consequence of newly diagnosed cardiovascular complications following a stroke is unclear. The aim of the present study was to investigate the incidence and long-term clinical outcomes of newly diagnosed cardiovascular complications following incident ischemic stroke. Methods: A retrospective cohort study was conducted using anonymized electronic medical records from 53 participating health care organizations. Patients with incident ischemic stroke aged ≥18 years with 5 years of follow-up were included. Patients who were diagnosed with new-onset cardiovascular complications (heart failure, severe ventricular arrhythmia, atrial fibrillation, ischemic heart disease, Takotsubo syndrome) within 4-weeks (exposure) of incident ischemic stroke were 1:1 propensity score-matched (age, sex, ethnicity, comorbidities, cardiovascular care) with ischemic stroke patients who were not diagnosed with a new-onset cardiovascular complication (control). Logistic regression models produced odds ratios (OR) with 95% CIs for 5-year incidence of all-cause mortality, recurrent stroke, hospitalization, and acute myocardial infarction. Results: Of 365 383 patients with stroke with 5-year follow-up: 11.1% developed acute coronary syndrome; 8.8% atrial fibrillation/flutter; 6.4% heart failure; 1.2% severe ventricular arrythmias; and 0.1% Takotsubo syndrome within 4 weeks of incident ischemic stroke. Following propensity score matching, odds of 5-year all-cause mortality were significantly higher in stroke patients with acute coronary syndrome (odds ratio, 1.49 [95% CI, 1.44–1.54]), atrial fibrillation/flutter (1.45 [1.40–1.50]), heart failure (1.83 [1.76–1.91]), and severe ventricular arrhythmias (2.08 [1.90–2.29]), compared with matched controls. Odds of 5-year rehospitalization and acute myocardial infarction were also significantly higher for patients with stroke diagnosed with new-onset cardiovascular complications. Takotsubo syndrome was associated with significantly higher odds of 5-year composite major adverse cardiovascular events (1.89 [1.29–2.77]). Atrial fibrillation/flutter was the only new-onset cardiac complication associated with significantly higher odds of recurrent ischemic stroke at 5 years (1.10 [1.07–1.14]). Conclusions: New-onset cardiovascular complications diagnosed following an ischemic stroke are very common and associate with significantly worse 5-year prognosis in terms of major adverse cardiovascular events. People with stroke and newly diagnosed cardiovascular complications had >50% prevalence of recurrent stroke at 5 years.

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confidence: 99%

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confidence: 99%

Stroke-Heart Syndrome: Incidence and Clinical Outcomes of Cardiac Complications Following Stroke

Buckley

Harrison

Hill

et al. 2022

Stroke

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Are Ischemic Strokes the Same? The Special Case Argument of Atrial Fibrillation

Ranasinghe

Gurol

2023

Cardiac Electrophysiology Clinics

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Are Ischemic Strokes the Same? The Special Case Argument of Atrial Fibrillation

Ranasinghe

Gurol

2022

Interventional Cardiology Clinics

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Advances in Neurocardiology: Focus on Atrial Fibrillation

Cited by 6 publications

References 13 publications

Stroke-Heart Syndrome: Incidence and Clinical Outcomes of Cardiac Complications Following Stroke

Stroke-Heart Syndrome: Incidence and Clinical Outcomes of Cardiac Complications Following Stroke

Are Ischemic Strokes the Same? The Special Case Argument of Atrial Fibrillation

Are Ischemic Strokes the Same? The Special Case Argument of Atrial Fibrillation

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