Rheumatic Mitral Valve Disease Is Associated With Worse Outcomes in Stroke

Abstract

Background and Purpose— Rheumatic valvular heart disease is associated with the increased risk of cerebrovascular events, although there are limited data on the prognosis of patients with rheumatic mitral valve disease (RMVD) after stroke. Methods— We examined the association between RMVD and both serious and common cardiovascular and noncardiovascular (respiratory and infective) complications in a cohort of hospitalized stroke patients based in Thailand. Factors associated with in-hospital mortality were also explored. Data were obtained from a National Insurance Database. All hospitalized strokes between October 1, 2004, and January 31, 2013, were included in the current study. Characteristics and outcomes were compared for RMVD and non-RMVD patients. Logistic regression, propensity score matching, and multivariate models were used to assess study outcomes. Results— In total, 594 681 patients (mean [SD] age=64 [14.5] years) with a diagnosis of stroke (ischemic=306 154; hemorrhagic=195 392; undetermined=93 135) were included in this study, of whom 5461 had RMVD. Results from primary analyses showed that after ischemic stroke, and controlling for potential confounding covariates, RMVD was associated ( P <0.001) with increased odds for cardiac arrest (odds ratio [95% confidence interval]=2.13 [1.68–2.70]), shock (2.13 [1.64–2.77]), arrhythmias (1.70 [1.21–2.39]), respiratory failure (2.09 [1.87–2.33]), pneumonia (2.00 [1.81–2.20]), and sepsis (1.39 [1.19–1.63]). In hemorrhagic stroke patients, RMVD was associated with increased odds (fully adjusted model) for respiratory failure (1.26 [1.01–1.57]), and in patients with undetermined stroke, RMVD was associated with increased odds (fully adjusted analyses) for shock (3.00 [1.46–6.14]), respiratory failure (2.70 [1.91–3.79]), and pneumonia (2.42 [1.88–3.11]). Conclusions— RMVD is associated with the development of cardiac arrest, shock, arrhythmias, respiratory failure, pneumonia, and sepsis after acute stroke.

<p>Clinical, Echocardiographic Characteristics and Management Practices in Patients with Rheumatic Valvular Heart Disease</p>

“…However, an earlier retrospective study by Melka et al 9 reported drug discontinuation was the most common precipitating factor. The difference might be due to the patients were retrospectively included in the study by Melka et al 9 Additionally, Wood et al 22 reported rheumatic mitral valve disease (RMVD) was associated with an increased risk of pneumonia (OR= (2.00 [1.81-2.20])). In patients who were diagnosed before the current admission, rheumatic recurrence was documented in 6.4% of patients.…”

Impact of Diabetes on Complications, Long Term Mortality and Recurrence in 608,890 Hospitalised Patients with Stroke

“…The data source has been previously described [12]. Briefly, in Thailand, the diagnosis of stroke is made during hospitalisation by attending clinical teams based on the clinical features and investigation findings, including brain imaging.…”

“…In the current study, we aimed to compare the demographic characteristics and relevant post-stroke outcomes (in-hospital complications, short and long-term mortality and stroke recurrence) between patients with DM and those without DM diagnosed with IS, HS and undetermined strokes in a large, prospectively collected, insurance-based multi-centre stroke register database from Thailand [12].…”

Infective endocarditis is associated with worse outcomes in stroke: A Thailand National Database Study

“…The Social Security scheme covers private sector employees (≈13% of the population). The Universal Coverage Health Security Scheme is a basic health insurance scheme covering the remaining ~75% of the population 12 …”