Heart Failure, Dementia is Associated with Increased Stroke Severity, in-Hospital Mortality and Complications

BACKGROUND: Heart failure (HF) is a risk factor for ischemic stroke. Cognitive impairment is very common in HF and stroke patients. Patients with HF have higher risk of developing dementia. However, there are limited studies investigating the characteristics, in-hospital mortality and complications of stroke patients with both HF and dementia. METHODS AND RESULTS: Patients in this study were from the China Stroke Center Alliance database. We divided patients into four groups: (A) stroke patients with dementia but no HF; (B) stroke patients with HF but no dementia; (C) stroke patients with both dementia and HF; (D) stroke patients without HF or dementia. We analysed the in-hospital mortality, and complications among the 4 groups. Outcomes include in-hospital mortality and in-hospital complications, including pneumonia, decubitus ulcer, pulmonary embolism, myocardial infarction, gastrointestinal bleeding and deep vein thrombosis (DVT). Multivariable logistic regression was performed to validate the association between HF, dementia, stroke and functional outcomes. Stroke patients with dementia and HF were older, and had a higher proportion of individuals with a history of strokeperipheral vascular disease and dyslipidaemia, and had a higher level of homocysteine, glycosylated hemoglobin and so on. Compared with group D (stroke patients without HF or dementia), all the other three groups have significantly higher proportion of in-hospital mortality and complications, such as pneumonia, decubitus ulcer, pulmonary embolism, myocardial infarction, DVT, gastrointestinal bleeding and poor swallow function. When compared with group B (stroke patients with HF but no dementia), the in-hospital mortality was higher in group C (stroke patients with HF and dementia), but the difference was not statistically significant; the prevalence of decubitus ulcer, gastrointestinal bleeding and poor wallow function were significantly higher in group C. In the logistic regression, the stroke patients with dementia and HF showed significant higher in-hospital mortality (adjusted OR, 2.875; 95% CI, 1.539-5.371; P = 0.001) and higher proportion of pneumonia (adjusted OR 2.596, 95% CI, 2.027-3.325, P < 0.001), decubitus ulcer (adjusted OR, 6.473, 95% CI, 3.999-10.477, P < 0.001) and pulmonary embolism (adjusted OR, 2.876, 95% CI, 1.054-7.850, P = 0.039). CONCLUSIONS: Stroke patients with dementia and HF have an increased risk of in-hospital mortality and complications. Future studies should strengthen the risk factor control among individuals with both dementia and HF for stroke prevention.