Risk prediction for mortality and cardiovascular events in post-stroke patients after one year of follow-up: the Liverpool-Heart and bRain Project

Background Identifying risk factors for death and cardiovascular events in post-stroke patients is important for targeted screening and intervention strategies. Purpose To identify predictors of mortality and cardiovascular events, including major adverse cardiovascular events (MACE), recurrent stroke, and incident atrial fibrillation (AF), in post-stroke patients. Methods Between September 2021 and December 2022, patients with ischaemic stroke were recruited from 35 UK hospitals. Demographics and clinical data were recorded at baseline. All-cause mortality, MACE, recurrent stroke and incident AF during 12-month follow-up were recorded. Results 1,655 patients (median age: 71 [IQR: 61, 79]; 59% male) were recruited (Table). During the 12-month follow-up, 147 (8.9%) patients died, 92 (5.6%) developed MACE, 63 (3.8%) experienced recurrent stroke, and 138 (8.4%) developed incident AF. Patients who died were older and more likely to have hypertension, diabetes, AF, congestive heart failure (CHF), vascular disease, higher National Institutes of Health Stroke Scale (NIHSS) score, and lower systolic blood pressure (BP) and body mass index (BMI). Multivariable logistic regression showed that age (OR: 1.08, 95%CI: [1.05-1.10]), alcohol units (1.02, [1.01-1.03]), BMI (0.95, [0.91-0.99]), systolic BP (0.99, [0.98-1.00]), and diabetes (1.66, [1.03-2.67]) were associated with all-cause death (Figure). Diabetes (2.66, [1.21-3.66]) and vascular disease (2.64, [1.03-6.75]) were associated with MACE, while only diabetes (1.99, [1.03-3.83]) was associated with recurrent stroke. Age (1.05, [1.03-1.08]), male sex (2.12, [1.17-3.82]), and systolic BP (0.98, [0.97-0.99]) were predictors of incident AF. Conclusions In this post-stroke cohort, the 12-month mortality rate was 8.9%. Diabetes was consistently associated with adverse outcomes, including all-cause mortality, MACE, and recurrent stroke. Targeted management of comorbidities is essential for reducing 12-month mortality and secondary cardiovascular events in post-stroke patients.