Characterisation of Incident Heart Failure after Ischaemic Stroke/Transient Ischaemic Attack: A UK Biobank Study

AIMS: To define incident heart failure (HF) risk in ischaemic stroke/TIA survivors. The secondary aims were to define the association of HF with all-cause mortality in stroke survivors and to describe their cardiac magnetic resonance (CMR) findings. METHODS: This was a prospective cohort study using the UK Biobank (UKBB) cohort of individuals aged 40 to 69-years-old. We excluded individuals with prior HF and stratified them by history of ischaemic stroke/TIA. The main outcome was incident HF as defined by hospital admissions coded for heart failure. Secondary outcomes were all-cause mortality, myocardial infarction and CMR findings. RESULTS: We included 405,406 individuals (age 56.5 years, 45.6% males). Over 13.7 years, 15,565 individuals experienced incident HF. Stroke survivors had an overall HR of 3.6 (95% confidence interval 3.3 to 3.8, p<0.0001) for HF hospitalization and an adjusted HR of 1.4 (95% confidence interval 1.3 to 1.5, p<0.0001). The risk of HF hospitalization was greater than the risk of myocardial infarction (12.6% vs 5.4%). Stroke survivors with HF had a lower LVEF and higher LV mass than those without HF. Incident HF in stroke survivors was associated with a HR of 1.8 (95% confidence interval 1.6 to 1.9, p<0.0001) for mortality. CONCLUSIONS: Incident HF is common in stroke survivors and strongly associates with mortality. The risk of HF varies greatly depending on underlying risk factors. Exploratory analyses suggest that stroke survivors with HF may have a lower ejection fraction phenotype. Future trials of HF preventive therapy in high-risk stroke survivors are warranted.