Key result
Patients with heart failure and a history of stroke had a significantly higher risk of all-cause mortality at 3 years compared to those without stroke (HR 1.43; 95% CI 1.07-1.91; p=0.016).
Why the study?
Differences in psychosocial, behavioural, and clinical outcomes between heart failure patients with and without stroke were not clearly defined.
Does a history of stroke worsen psychosocial, behavioural, and clinical outcomes in patients with heart failure?
Cohort (n=1,023)
Yes
Does a history of stroke worsen psychosocial, behavioural, and clinical outcomes in patients with heart failure?
Patients with heart failure and a history of stroke have significantly worse long-term psychosocial, behavioural, and clinical outcomes, including higher 3-year mortality, compared to those without stroke.
Answers are grounded in this paper and cite their sources.
HF patients with stroke history may warrant closer monitoring; leaves open whether targeted interventions improve outcomes.
OBJECTIVE: To identify differences in psychosocial, behavioural and clinical outcomes between patients with heart failure (HF) with and without stroke. DESIGN AND PARTICIPANTS: A secondary analysis of 1023 patients with heart failure enrolled in the Coordinating study evaluating Outcomes of Advising and Counselling in Heart failure. SETTING: Seventeen hospitals located across the Netherlands. OUTCOMES MEASURES: Depressive symptoms (Centre for Epidemiological Studies Depression Scale), quality of life (Minnesota Living with Heart Failure Questionnaire, Ladder of Life Scale), self-care (European Heart Failure Self-Care Behaviour Scale), adherence to HF management (modified version of the Heart Failure Compliance Questionnaire) and readmission for HF, cardiovascular-cause and all-cause hospitalisations at 18 months, and all-cause mortality at 18 months and 3 years. RESULTS: Compared with those without stroke, patients with HF with a stroke (10.3%; n=105) had twice the likelihood of severe depressive symptoms (OR 2.83, 95% CI 1.27 to 6.28, p=0.011; OR 2.24, 95% CI 1.03 to 4.88, p=0.043) at 12 and 18 months, poorer disease-specific and generic quality of life (OR 2.80, 95% CI 1.61 to 4.84, p<0.001; OR 2.00, 95% CI 1.09 to 3.50, p=0.019) at 12 months, poorer self-care (OR 1.80, 95% CI 1.05 to 3.11, p=0.034; OR 2.87, 95% CI 1.61 to 5.11, p<0.0011) and HF management adherence (OR 0.39, 95% CI 0.18 to 0.81, p=0.012; OR 0.35, 95% CI 0.17 to 0.72, p=0.004) at 12 and 18 months, higher rates of hospitalisations and mortality at 18 months and higher all-cause mortality (HR 1.43, 95% CI 1.07 to 1.91, p=0.016) at 3 years. CONCLUSIONS: Patients with HF and stroke have worse psychosocial, behavioural and clinical outcomes, notably from 12 months, than those without stroke. To ameliorate these poor outcomes long-term, integrated disease management pathways are warranted.
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Ski et al. (2019) conducted a cohort in Heart failure (n=1,023). History of stroke vs. No history of stroke was evaluated on All-cause mortality at 3 years (HR 1.43, 95% CI 1.07 to 1.91, p=0.016). Patients with heart failure and a history of stroke had a significantly higher risk of all-cause mortality at 3 years compared to those without stroke (HR 1.43; 95% CI 1.07-1.91; p=0.016).
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