Congestive cardiac failure (CCF) as a cause of fatal stroke and all cause death

BACKGROUND: Congestive cardiac failure (CCF) has been found to be a clinical risk factor for stroke in patients with non rheumatic atrial fibrillation. AIMS: To study CCF as a risk factor for stroke deaths and all cause deaths in coronary heart disease (CHD). METHODS: Case control study from a single cardiologist's practice: 370 deaths, 32 (9%) from stroke; controls of 160 and 370 consecutive patients for stroke deaths and all cause deaths respectively. Multivariate analysis using logistic regression. RESULTS: A--Stroke deaths. Positive associations for CHD with CCF, hypertension; negative association for CHD without CCF. Patients with CHD and CCF were 7.4 times as likely to die from stroke as patients with CHD without CCF. B--All cause deaths. Positive associations for CHD or cardiomyopathy with CCF, atrial fibrillation, diabetes and hypertension; negative association for CHD without CCF. Patients with CHD and CCF were 6.1 times as likely to die from all causes as patients with CHD without CCF. CONCLUSIONS: Many stroke deaths in patients with CHD and CCF may be cardioembolic in origin. A randomised controlled trial in such patients is indicated to see if anticoagulants can reduce the incidence of stroke.