Patients with heart failure with and without a history of stroke in the Netherlands: a secondary analysis of psychosocial, behavioural and clinical outcomes up to three years from the COACH trial

Abstract

ObjectiveTo identify differences in psychosocial, behavioural and clinical outcomes between patients with heart failure (HF) with and without stroke.Design and participantsA secondary analysis of 1023 patients with heart failure enrolled in the Coordinating study evaluating Outcomes of Advising and Counselling in Heart failure.SettingSeventeen hospitals located across the Netherlands.Outcomes measuresDepressive symptoms (Centre for Epidemiological StudiesDepressionScale), quality of life (Minnesota Living with Heart Failure Questionnaire, Ladder of Life Scale), self-care (European Heart Failure Self-Care Behaviour Scale), adherence to HF management (modified version of the Heart Failure Compliance Questionnaire) and readmission for HF, cardiovascular-cause and all-cause hospitalisations at 18 months, and all-cause mortality at 18 months and 3 years.ResultsCompared with those without stroke, patients with HF with a stroke (10.3%; n=105) had twice the likelihood of severe depressive symptoms (OR 2.83, 95% CI 1.27 to 6.28, p=0.011; OR 2.24, 95% CI 1.03 to 4.88, p=0.043) at 12 and 18 months, poorer disease-specific and generic quality of life (OR 2.80, 95% CI 1.61 to 4.84, p<0.001; OR 2.00, 95% CI 1.09 to 3.50, p=0.019) at 12 months, poorer self-care (OR 1.80, 95% CI 1.05 to 3.11, p=0.034; OR 2.87, 95% CI 1.61 to 5.11, p<0.0011) and HF management adherence (OR 0.39, 95% CI 0.18 to 0.81, p=0.012; OR 0.35, 95% CI 0.17 to 0.72, p=0.004) at 12 and 18 months, higher rates of hospitalisations and mortality at 18 months and higher all-cause mortality (HR 1.43, 95% CI 1.07 to 1.91, p=0.016) at 3 years.ConclusionsPatients with HF and stroke have worse psychosocial, behavioural and clinical outcomes, notably from 12 months, than those without stroke. To ameliorate these poor outcomes long-term, integrated disease management pathways are warranted.

S2I2N0–3 score predicts short‐ and long‐term mortality and morbidity in HFrEF: a post‐hoc analysis of the GUIDE‐IT trial

“…The stroke–heart syndrome is thought to confer an additional two‐ to three‐fold risk of mortality during short‐term follow‐up 25 . In a secondary analysis of the COACH trial, stroke history was shown to be associated with adverse outcomes in HF patients, as compared with those without stroke history, HF patients with stroke had higher risk rates of HF rehospitalization and all‐cause death in 18 months and all‐cause death in 3 years 8 . In this analysis, stroke was significantly associated with an elevated risk of all‐cause mortality, HF hospitalization, and the composite endpoint of CV death and HF hospitalization during 90 days of follow‐up, whereas the relationship attenuated as time increased.…”

“…6,7 Of note, each of the three individual components of the S 2 I 2 N 0-3 score has a positive association with prognosis in patients with HF. [8][9][10] As such, it would be interesting to assess whether this simple S 2 I 2 N 0-3 score also keeps high effective values in predicting mortality and morbidity in patients with HFrEF. The score's innovation lies in its streamlined approach, which contrasts with more complex models, and its inclusion of biomarkers with robust predictive values, addressing a significant gap in HF risk assessment.…”

“…More recently, the simple S 2 I 2 N 0–3 risk score containing three variables [stroke history, insulin‐treated diabetes mellitus (DM), and plasma N‐terminal pro‐brain natriuretic peptide (NT‐proBNP) level] has been developed for predicting stroke in HFrEF patients 6,7 . Of note, each of the three individual components of the S 2 I 2 N 0–3 score has a positive association with prognosis in patients with HF 8–10 . As such, it would be interesting to assess whether this simple S 2 I 2 N 0–3 score also keeps high effective values in predicting mortality and morbidity in patients with HFrEF.…”