Key result
Prior stroke is linked to ~69% higher incident HF risk, particularly with severe disability.
Why the study?
Stroke-induced cardiac damage may lead to lifelong cardiac problems such as heart failure, but the comparative incidence of heart failure between stroke survivors and the general non-stroke population needed clarification.
Does prior stroke increase the risk of incident heart failure compared to a matched non-stroke population?
Cohort (n=440,462)
Does prior stroke increase the risk of incident heart failure compared to a matched non-stroke population?
Hazard Ratio: 1.69 (95% CI 1.65–1.73)
Stroke survivors have a significantly higher risk of developing incident heart failure compared to matched controls, highlighting the need for cardiovascular monitoring in this population.
May warrant closer HF monitoring post-stroke; extends observational links but leaves causal mechanisms and interventions open.
Background/Objectives: Stroke-induced cardiac damage may lead to lifelong cardiac problems, such as heart failure (HF). We aimed to compare the incidence of HF between stroke survivors and the general non-stroke population. Methods: We performed a population-based study of individuals in the Korean National Health Insurance Service database. We included 220,231 stroke survivors between 2010 and 2018 and 1:1 age- and sex-matched non-stroke controls. The study outcome was HF and the cohort was followed up until 2019. Cox hazards models were used to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for HF risk. Results: At baseline, stroke survivors had a substantially higher comorbidity burden than matched controls (Charlson Comorbidity Index 4.1 vs. 1.6), with higher rates of hypertension, type 2 diabetes, and dyslipidemia, and were more likely to be current smokers and heavy drinkers. Stroke survivors showed a higher risk for HF (aHR 1.69, 95% CI 1.65–1.73) compared to controls. The risks were further increased with disability, as demonstrated in comparison of those with mild disability (aHR 1.78, 95% CI 1.70–1.87) and those with severe disability (aHR 2.22, 95% CI 2.10–2.36). Before applying the 1-year lag period, the association appeared more prominent among hemorrhagic stroke survivors than ischemic stroke survivors. However, following the 1-year lag period, the HF risk was similar between stroke subtypes (hemorrhagic stroke with disability: aHR 1.77, 95% CI 1.62–1.93; ischemic stroke with disability: aHR 1.71, 95% CI 1.63–1.80). Propensity score matching incorporating all baseline characteristics confirmed the robustness of the primary findings. Conclusions: Stroke survivors, who had a greater burden of cardiovascular risk factors, were at significantly greater risk for incident HF compared with age- and sex-matched non-stroke controls, particularly those with disability. Clinicians need to be aware of the importance of HF in stroke survivors who have multiple comorbidities and disability.
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Yoo et al. (2026) conducted a cohort in Stroke (n=440,462). Prior stroke vs. Age- and sex-matched non-stroke controls was evaluated on Incident heart failure (HF) (aHR 1.69, 95% CI 1.65-1.73). Prior stroke was associated with a significantly higher risk of incident heart failure compared to non-stroke controls (aHR 1.69; 95% CI 1.65–1.73), particularly among those with severe disability.
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