Acute Decompensated Heart Failure Complicated by Ischemic Stroke and Its Association With Hemoglobin Levels

Q: What are the key findings of this study?

Non-anemia at hospitalization was independently associated with an increased risk of early-phase ischemic stroke within 30 days after acute decompensated heart failure (sHR 2.04).

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Acute decompensated heart failure (n=5106). Intervention: Non-anemia (high hemoglobin levels) vs. Anemia. Primary outcome: Early-phase ischemic stroke (≤30 days after hospitalization) (sHR 2.04, 95% CI 1.09-3.82, p=0.03).

Q: What does this research mean for the field?

Non-anemia is independently associated with a 104% increased risk of early-phase ischemic stroke in patients hospitalized for acute decompensated heart failure. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Yusuke Yamazaki; Yasuyuki Shiraishi; Shun Kohsaka; Seiji Ikegami; Takashi Kohno; Yuji Nagatomo; M Kitamura; Munehisa Sakamoto; Michiru Nomoto; Toshiyuki Takahashi; Masatake Kobayashi; Satoshi Higuchi; Masaki Ieda; Tsutomu Yoshikawa; for the West Tokyo Heart Failure Registry Investigators

doi:10.1253/circrep.cr-26-0015

March 12, 2026Circulation ReportsOpen Access

Acute Decompensated Heart Failure Complicated by Ischemic Stroke and Its Association With Hemoglobin Levels

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Key result

Non-anemia at ADHF admission linked to ~104% higher risk of 30-day ischemic stroke.

sHR 2.04
95% CI 1.09-3.82
P=0.03
n=5,106

Figures

Why the study?

Ischemic stroke is a serious but underexplored complication of acute decompensated heart failure.

Does non-anemia increase the risk of ischemic stroke in patients hospitalized for acute decompensated heart failure?

Key Points

To evaluate the incidence, clinical subtypes, and phase-specific association between hemoglobin levels and ischemic stroke risk in acute decompensated heart failure.
Followed 5,106 patients hospitalized for acute decompensated heart failure over a median duration of 13 months (IQR 10–25 months).
Compared early-phase (onset within 30 days) and late-phase ischemic stroke using multivariable Fine-Gray subdistribution hazard models to account for the competing risk of death and time-varying Cox proportional hazards models.
Ischemic stroke occurred in 115 (2.3%) patients, predominantly cardioembolic (61.7%), with early-phase events clustering within the first 2 weeks after admission at a median onset of 7 days (IQR 3–12 days; Ptrend=0.002).
Non-anemia was independently associated with an increased risk of early-phase ischemic stroke (subdistributional hazard ratio 2.04; 95% confidence interval 1.09–3.82; P=0.03), but showed no significant association with late-phase ischemic stroke (adjusted hazard ratio 1.21; 95% confidence interval 0.65–2.23; P=0.55).

Study Design

Type

Cohort (n=5,106)

Multicenter

Yes

Structured PICO

Does non-anemia increase the risk of ischemic stroke in patients hospitalized for acute decompensated heart failure?

P

Population

5,106 adults hospitalized for acute decompensated heart failure, excluding those with acute coronary syndrome, followed for a median of 13 months.

E

Exposure

Non-anemia (hemoglobin ≥13 g/dL in men and ≥12 g/dL in women) at the time of hospitalization

C

Comparator

Anemia (hemoglobin <13 g/dL in men and <12 g/dL in women) at the time of hospitalization

O

Outcome

Incidence of ischemic stroke (IS) after ADHF hospitalization, defined as new focal neurological symptoms lasting ≥24 h, confirmed by CT or MRI, and adjudicated by board-certified neurologistshard clinical

Main Result

Hazard Ratio: 2.04 (95% CI 1.09–3.82)

p-value: p=0.03

Non-anemia (higher hemoglobin levels) is independently associated with an increased risk of early-phase ischemic stroke within 30 days after hospitalization for acute decompensated heart failure.

Limitations

Small number of outcome events may have reduced statistical power.
Anemia subtypes and iron status were not assessed.
Lack of systematic diagnostic data (e.g., transesophageal echocardiography) prevented evaluation of specific ischemic stroke mechanisms.
Exclusion of patients with acute coronary syndrome limits generalizability.
Hemoglobin trajectories beyond 3 time points were not captured, limiting the assessment of long-term effects.
Limited number of events precluded stable fully adjusted spline modeling
Low use of sacubitril/valsartan and SGLT2 inhibitors in the cohort

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Implication

Non-anemic patients with acute decompensated heart failure may need closer early stroke monitoring; leaves open whether hemoglobin levels are causal or modifiable.

Abstract

Background: Ischemic stroke (IS) is a serious but underexplored complication of acute decompensated heart failure (ADHF). We assessed the incidence, subtypes, and phase-specific association between hemoglobin and IS risk. Methods and Cardioembolic stroke (61.7%) predominated across both phases. Early-phase IS patients were younger, had less prior anticoagulant use, and had higher hemoglobin levels. In multivariable Fine-Gray models accounting for competing risk of death, non-anemia was independently associated with increased early-phase IS risk (subdistributional hazard ratio 2.04; 95% confidence interval 1.09-3.82; P=0.03), but not with late-phase IS. Conclusions: IS occurred most frequently within 30 days after ADHF hospitalization, and was predominantly cardioembolic. Non-anemia identified patients at higher risk of IS in the early phase, suggesting its potential value for early risk stratification.

Cite This Study

Yamazaki et al. (2026) conducted a cohort in Acute decompensated heart failure (n=5,106). Non-anemia (high hemoglobin levels) vs. Anemia was evaluated on Early-phase ischemic stroke (≤30 days after hospitalization) (sHR 2.04, 95% CI 1.09-3.82, p=0.03). Non-anemia at hospitalization was independently associated with an increased risk of early-phase ischemic stroke within 30 days after acute decompensated heart failure (sHR 2.04).

synapsesocial.com/papers/69b64c67b42794e3e660daeb https://doi.org/10.1253/circrep.cr-26-0015

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Acute Decompensated Heart Failure Complicated by Ischemic Stroke and Its Association With Hemoglobin Levels

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Discussion

Implication

Abstract

Cite This Study

Acute Decompensated Heart Failure Complicated by Ischemic Stroke and Its Association With Hemoglobin Levels

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Discussion

Implication

Abstract

Cite This Study

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