Stroke increased all-cause mortality risk in heart failure patients (HR 2.49), with especially high risk in women and those with valvular cardiomyopathy.
Are there gender differences in all-cause mortality among patients with heart failure and previous stroke?
In patients with heart failure, previous stroke is a strong independent predictor of all-cause mortality, with women with stroke having a particularly unfavorable prognosis compared to men.
Absolute Event Rate: 0% vs 0%
Abstract Purpose to analyse gender differences in all-cause mortality in patients with HF and previous stroke. Methods From February 2017 to January 2022, we analysed mortality and predictors of all-cause death in women and men with HF. Baseline data included clinical features and echocardiographic findings. The analysed comorbidities were previous stroke, previous myocardial infarction (MI), diabetes, atrial fibrillation (AF), and chronic kidney disease (CKD). We used the Kaplan-Meier method (K-M) and Cox proportional hazards methods to analyse mortality rates. Predictors of death were obtained using the score chi-square of Cox regression. Results We analysed, in a mean follow-up period of 2.2±0.9 years, 11,282 patients with a mean age of 63.9 ± 14.4 years, and 6,256 (55.4%) were men. Patients with previous strokes were older (66.1±13.7 vs. 63.8±14.4 years; p0.0001), had lower initial left ventricular ejection fraction (44.4 ±16.4% vs. 46.3±16%; p=0.009), and greater initial left ventricular diastolic diameter (58.5±10.4 vs. 57.2±9.6 mm; p=0.010). The prevalence of ischemic cardiomyopathy was higher in men (p=0.010), while hypertensive cardiomyopathy (CMP) (p=0.029) and valvular CMP (p=0.025) were more prevalent in women. The prevalence of heart failure with reduced ejection fraction was higher in men (p0.001), whereas heart failure with preserved ejection fraction was more common in women (p0.001). The cumulative incidence of death was higher in men without stroke (p=0.040) compared to women without stroke, and in women with stroke (p0.001) compared to men with stroke (Figure). Cox regression for death, adjusted for age, gender, initial LVEF, ischemic CMP, idiopathic CMP, hypertensive CMP, valvular CMP, diabetes, CKD, AF, and stroke, showed, in decreasing order of importance, CKD HR=2.76 (95% CI: 2.51-3.03); p0.001, stroke HR=2.49 (95% CI: 2.20-2.81); p0.001, diabetes HR=2.06 (95% CI: 1.88-2.26); p0.001, AF HR=1.87 (95% CI: 1.71-2.04); p0.001, age HR=1.02 (95% CI: 1.01-1.02); p0.001, LVEF HR=0.77 (95% CI: 0.73-0.81); p0.001, and valvular CMP HR=1.65 (95% CI: 1.45-1.87); p0.001 as independent variables for death in the total population. For patients with HF and stroke, Cox regression adjusted for the same variables showed CKD HR=1.43 (95% CI: 1.12-1.83); p0.001, valvular CMP HR=1.71 (95% CI: 1.25-2.36); p=0.001, diabetes HR=1.51 (95% CI: 1.19-1.92); p=0.001, LVEF HR=0.75 (95% CI: 0.66-0.86); p=0.001, and age HR=1.02 (95% CI: 1.01-1.03); p=0.005 as independent variables for death. Conclusion Stroke was one of the leading independent variables associated with mortality from all causes in the analysed sample, with a particularly unfavourable prognosis in patients with valvular CMP and in women with stroke. These findings highlight the importance of preventive and therapeutic strategies aimed at reducing the impact of stroke, especially in high-risk populations.Figure
Mansur et al. (Sat,) reported a other. Stroke increased all-cause mortality risk in heart failure patients (HR 2.49), with especially high risk in women and those with valvular cardiomyopathy.