Mortality and Morbidity in Acute Heart Failure with Cerebrovascular Accident (Stroke/Transient Ischemic Attack) Stratified by Ejection Fraction

Abstract Background: Heart failure (HF) is a prevalent condition in our society, frequently accompanied by various interacting comorbidities. Among these, brain-related comorbidities such as stroke and transient ischemic attack (TIA) play a crucial role in exacerbating the severity of HF. The relationship between cerebrovascular accidents (CVAs) and HF across different left ventricular ejection fraction (LVEF) levels is not well understood. Objectives: This study aims to assess the impact of CVA including stroke and TIA on mortality and morbidity in patients with acute heart failure (AHF) stratified by LVEF. Methods: We conducted an analysis of consecutive patients admitted to 47 hospitals in seven Middle Eastern countries (Saudi Arabia, Oman, Yemen, Kuwait, United Arab Emirates, Qatar, and Bahrain) with AHF from February to November 2012 with AHF who were enrolled in a multinational registry of patients with HF. The study population consisted of patients with CVA and AHF, categorized into three groups based on EF: HF patients with preserved EF (HFpEF) (250%), HF patients with reduced EF (HFrEF) (<40%), and HF patients with mid-range EF (HFmrEF) (40%–49%). Univariate and multivariate statistical techniques were employed for the analysis. Results: Our study involved 370 patients, averaging 66.4 ± 13.2 years. In-hospital mortality for CVA and AHF patients was 8.4% ( n = 31). Patients in different ranges of LVEF experienced comparable rates of hospitalization and mortality at both the 3-month and 12-month intervals. Left atrial enlargement (odd ratio OR: 3.27, 95% confidence interval CI: 1.33–9.32, P = 0.015) and noninvasive ventilation (OR: 6.17, 95% CI: 2.71–14.07, P < 0.001) were associated with a higher mortality rate while discharging on digoxin (OR: 0.14, 95% CI: 0.02–0.52, P = 0.011) was linked to lower mortality. The sole distinction among HF groups was observed in 12-month survival, with HFpEF patients having a superior survival rate of 91.7% compared to HFIEF patients at 77.5% and HFmrEF at 77.8% during this period. Conclusions: This study found significant differences in all-cause mortality at 12 months. Further research is warranted to better understand the mechanisms underlying these associations.