In-Hospital Outcomes of Acute Ischemic Stroke in Patients With Hypertrophic Cardiomyopathy

Q: What are the key findings of this study?

Patients with hypertrophic cardiomyopathy hospitalized for acute ischemic stroke had a significantly higher in-hospital mortality rate compared to those without the condition (6.3% vs 4.1%, OR 1.35).

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Acute Ischemic Stroke and Hypertrophic Cardiomyopathy (n=63991). Intervention: Hypertrophic Cardiomyopathy (Exposure) vs. Patients without Hypertrophic Cardiomyopathy. Primary outcome: In-hospital death (OR 1.35, p=<0.001).

Daokun Sun; Hartzell V. Schaff; Rick A. Nishimura; Jeffrey B. Geske; Joseph A. Dearani; Steve R. Ommen

doi:10.1016/j.mayocpiqo.2022.12.003

December 30, 2022Mayo Clinic Proceedings Innovations Quality & OutcomesOpen Access

In-Hospital Outcomes of Acute Ischemic Stroke in Patients With Hypertrophic Cardiomyopathy

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Key result

Hypertrophic cardiomyopathy is linked to ~35% higher in-hospital mortality in acute ischemic stroke patients.

OR 1.35
P<0.001
n=63,991

Figures

Why the study?

To investigate the in-hospital outcomes of acute ischemic stroke in patients with hypertrophic cardiomyopathy.

Does the presence of hypertrophic cardiomyopathy worsen in-hospital outcomes in adult patients admitted for acute ischemic stroke?

Study Design

Type

Cross-Sectional (n=63,991)

Multicenter

Yes

Structured PICO

Does the presence of hypertrophic cardiomyopathy worsen in-hospital outcomes in adult patients admitted for acute ischemic stroke?

P

Population

63,983 nonelective hospitalizations for acute ischemic stroke in adult patients between 2011 and 2017 from the National Inpatient Sample (5,804 with hypertrophic cardiomyopathy and 58,179 without).

I

Intervention

Presence of hypertrophic cardiomyopathy (HCM)

C

Comparator

Absence of hypertrophic cardiomyopathy (adult patients without HCM selected using simple random sampling)

O

Outcome

In-hospital outcomes

Main Result

Effect estimate: OR 1.35

Absolute Event Rate: 6.3% vs 4.1%

p-value: p=<0.001

Patients with hypertrophic cardiomyopathy experience worse in-hospital outcomes following acute ischemic stroke, highlighting the critical need for aggressive management of predisposing factors like atrial fibrillation.

Limitations

Lack of granular information of individual patients
Inability of the data to identify patients with a history of stroke or transient ischemic attack before the index event
Cross-sectional design cannot address the causal association of ischemic stroke with traditional cardiovascular risk factors
Accuracy of data coding in administrative data sets
Only included hospitalizations with acute ischemic stroke coded as the primary diagnosis, underestimating overall prevalence

Implication

May warrant heightened vigilance in HCM stroke admissions; leaves open whether targeted interventions improve outcomes.

Abstract

Objective: To investigate the in-hospital outcomes of acute ischemic stroke in patients with hypertrophic cardiomyopathy (HCM). Patients and Methods: Using weighted discharge data from the National Inpatient Sample, we identified 5804 nonelective hospitalizations for ischemic stroke in adult patients with HCM between 2011 and 2017. For comparison, 58,179 hospitalizations for ischemic stroke in adult patients without HCM were selected as controls using the simple random sampling method. Conclusion: The prognosis of acute ischemic stroke is worse in patients with HCM than in those without HCM. These findings emphasize the importance of aggressive treatment of predisposing factors for stroke in patients with HCM, especially atrial fibrillation.

Discussion

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Cite This Study

Sun et al. (2022) conducted a cross-sectional in Acute Ischemic Stroke and Hypertrophic Cardiomyopathy (n=63,991). Hypertrophic Cardiomyopathy (Exposure) vs. Patients without Hypertrophic Cardiomyopathy was evaluated on In-hospital death (OR 1.35, p=<0.001). Patients with hypertrophic cardiomyopathy hospitalized for acute ischemic stroke had a significantly higher in-hospital mortality rate compared to those without the condition (6.3% vs 4.1%, OR 1.35).

synapsesocial.com/papers/6a0e9e6825c30b2cc7f99d62 https://doi.org/10.1016/j.mayocpiqo.2022.12.003

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In-Hospital Outcomes of Acute Ischemic Stroke in Patients With Hypertrophic Cardiomyopathy

Figures

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

In-Hospital Outcomes of Acute Ischemic Stroke in Patients With Hypertrophic Cardiomyopathy

Figures

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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