Identifying a high stroke risk subgroup in individuals with heart failure

Patrick M. Pullicino, Leslie A. McClure, Virginia J. Howard, Virginia G. Wadley, Monika M. Safford, James F Meschia, Aaron Anderson, George Howard, Elsayed Z. Soliman

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Background: Heart failure (HF) is associated with an overall stroke rate that is too low to justify anticoagulation in all patients. This study was conducted to determine if vascular risk factors can identify a subgroup of individuals with heart failure with a stroke rate high enough to warrant anticoagulation. Methods: The REGARDS study is a population-based cohort of US adults aged ≥45 years. Participants are contacted every 6 months by telephone for self- or proxy-reported stroke and medical records are retrieved and adjudicated by physicians. Participants were characterized into 3 groups: HF without atrial fibrillation (AF), AF with or without HF, and neither HF nor AF. Cardiovascular risk factors at baseline were compared between participants with and without incident stroke in HF and AF. Stroke incidence was assessed in risk factor subgroups in HF participants. Results: Of the 30,239 participants, those with missing/anomalous data were excluded. Of the remaining 28,832, 1360 (5%) had HF without AF, 2528 (9%) had AF, and 24,944 (86%) had neither. Previous stroke/transient ischemic attack (TIA; P =.0004), diabetes mellitus (DM; P =.03), and higher systolic blood pressure (P =.046) were associated with increased stroke risk in participants with HF without AF. In participants with HF without AF, stroke incidence was highest in those with previous stroke/TIA and DM (2.4 [1.1, 4.0] per 100 person-years). Conclusions: The combination of previous stroke/TIA and DM increases the incidence of stroke in participants with HF without AF. No analyzed subgroup had a stroke rate high enough to make it likely that the benefits of warfarin would outweigh the risks.

Original languageEnglish (US)
Pages (from-to)620-626
Number of pages7
JournalJournal of Stroke and Cerebrovascular Diseases
Volume22
Issue number5
DOIs
StatePublished - Jul 2013

Fingerprint

Heart Failure
Stroke
Atrial Fibrillation
Incidence
Transient Ischemic Attack
Proxy
Warfarin
Telephone
Medical Records
Diabetes Mellitus
Blood Pressure
Hypertension
Physicians

Keywords

  • Heart failure
  • stroke
  • warfarin

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery
  • Rehabilitation
  • Cardiology and Cardiovascular Medicine

Cite this

Identifying a high stroke risk subgroup in individuals with heart failure. / Pullicino, Patrick M.; McClure, Leslie A.; Howard, Virginia J.; Wadley, Virginia G.; Safford, Monika M.; Meschia, James F; Anderson, Aaron; Howard, George; Soliman, Elsayed Z.

In: Journal of Stroke and Cerebrovascular Diseases, Vol. 22, No. 5, 07.2013, p. 620-626.

Research output: Contribution to journalArticle

Pullicino, PM, McClure, LA, Howard, VJ, Wadley, VG, Safford, MM, Meschia, JF, Anderson, A, Howard, G & Soliman, EZ 2013, 'Identifying a high stroke risk subgroup in individuals with heart failure', Journal of Stroke and Cerebrovascular Diseases, vol. 22, no. 5, pp. 620-626. https://doi.org/10.1016/j.jstrokecerebrovasdis.2011.10.012
Pullicino, Patrick M. ; McClure, Leslie A. ; Howard, Virginia J. ; Wadley, Virginia G. ; Safford, Monika M. ; Meschia, James F ; Anderson, Aaron ; Howard, George ; Soliman, Elsayed Z. / Identifying a high stroke risk subgroup in individuals with heart failure. In: Journal of Stroke and Cerebrovascular Diseases. 2013 ; Vol. 22, No. 5. pp. 620-626.
@article{a5fc12ff19294075afddc4bb0085a000,
title = "Identifying a high stroke risk subgroup in individuals with heart failure",
abstract = "Background: Heart failure (HF) is associated with an overall stroke rate that is too low to justify anticoagulation in all patients. This study was conducted to determine if vascular risk factors can identify a subgroup of individuals with heart failure with a stroke rate high enough to warrant anticoagulation. Methods: The REGARDS study is a population-based cohort of US adults aged ≥45 years. Participants are contacted every 6 months by telephone for self- or proxy-reported stroke and medical records are retrieved and adjudicated by physicians. Participants were characterized into 3 groups: HF without atrial fibrillation (AF), AF with or without HF, and neither HF nor AF. Cardiovascular risk factors at baseline were compared between participants with and without incident stroke in HF and AF. Stroke incidence was assessed in risk factor subgroups in HF participants. Results: Of the 30,239 participants, those with missing/anomalous data were excluded. Of the remaining 28,832, 1360 (5{\%}) had HF without AF, 2528 (9{\%}) had AF, and 24,944 (86{\%}) had neither. Previous stroke/transient ischemic attack (TIA; P =.0004), diabetes mellitus (DM; P =.03), and higher systolic blood pressure (P =.046) were associated with increased stroke risk in participants with HF without AF. In participants with HF without AF, stroke incidence was highest in those with previous stroke/TIA and DM (2.4 [1.1, 4.0] per 100 person-years). Conclusions: The combination of previous stroke/TIA and DM increases the incidence of stroke in participants with HF without AF. No analyzed subgroup had a stroke rate high enough to make it likely that the benefits of warfarin would outweigh the risks.",
keywords = "Heart failure, stroke, warfarin",
author = "Pullicino, {Patrick M.} and McClure, {Leslie A.} and Howard, {Virginia J.} and Wadley, {Virginia G.} and Safford, {Monika M.} and Meschia, {James F} and Aaron Anderson and George Howard and Soliman, {Elsayed Z.}",
year = "2013",
month = "7",
doi = "10.1016/j.jstrokecerebrovasdis.2011.10.012",
language = "English (US)",
volume = "22",
pages = "620--626",
journal = "Journal of Stroke and Cerebrovascular Diseases",
issn = "1052-3057",
publisher = "W.B. Saunders Ltd",
number = "5",

}

TY - JOUR

T1 - Identifying a high stroke risk subgroup in individuals with heart failure

AU - Pullicino, Patrick M.

AU - McClure, Leslie A.

AU - Howard, Virginia J.

AU - Wadley, Virginia G.

AU - Safford, Monika M.

AU - Meschia, James F

AU - Anderson, Aaron

AU - Howard, George

AU - Soliman, Elsayed Z.

PY - 2013/7

Y1 - 2013/7

N2 - Background: Heart failure (HF) is associated with an overall stroke rate that is too low to justify anticoagulation in all patients. This study was conducted to determine if vascular risk factors can identify a subgroup of individuals with heart failure with a stroke rate high enough to warrant anticoagulation. Methods: The REGARDS study is a population-based cohort of US adults aged ≥45 years. Participants are contacted every 6 months by telephone for self- or proxy-reported stroke and medical records are retrieved and adjudicated by physicians. Participants were characterized into 3 groups: HF without atrial fibrillation (AF), AF with or without HF, and neither HF nor AF. Cardiovascular risk factors at baseline were compared between participants with and without incident stroke in HF and AF. Stroke incidence was assessed in risk factor subgroups in HF participants. Results: Of the 30,239 participants, those with missing/anomalous data were excluded. Of the remaining 28,832, 1360 (5%) had HF without AF, 2528 (9%) had AF, and 24,944 (86%) had neither. Previous stroke/transient ischemic attack (TIA; P =.0004), diabetes mellitus (DM; P =.03), and higher systolic blood pressure (P =.046) were associated with increased stroke risk in participants with HF without AF. In participants with HF without AF, stroke incidence was highest in those with previous stroke/TIA and DM (2.4 [1.1, 4.0] per 100 person-years). Conclusions: The combination of previous stroke/TIA and DM increases the incidence of stroke in participants with HF without AF. No analyzed subgroup had a stroke rate high enough to make it likely that the benefits of warfarin would outweigh the risks.

AB - Background: Heart failure (HF) is associated with an overall stroke rate that is too low to justify anticoagulation in all patients. This study was conducted to determine if vascular risk factors can identify a subgroup of individuals with heart failure with a stroke rate high enough to warrant anticoagulation. Methods: The REGARDS study is a population-based cohort of US adults aged ≥45 years. Participants are contacted every 6 months by telephone for self- or proxy-reported stroke and medical records are retrieved and adjudicated by physicians. Participants were characterized into 3 groups: HF without atrial fibrillation (AF), AF with or without HF, and neither HF nor AF. Cardiovascular risk factors at baseline were compared between participants with and without incident stroke in HF and AF. Stroke incidence was assessed in risk factor subgroups in HF participants. Results: Of the 30,239 participants, those with missing/anomalous data were excluded. Of the remaining 28,832, 1360 (5%) had HF without AF, 2528 (9%) had AF, and 24,944 (86%) had neither. Previous stroke/transient ischemic attack (TIA; P =.0004), diabetes mellitus (DM; P =.03), and higher systolic blood pressure (P =.046) were associated with increased stroke risk in participants with HF without AF. In participants with HF without AF, stroke incidence was highest in those with previous stroke/TIA and DM (2.4 [1.1, 4.0] per 100 person-years). Conclusions: The combination of previous stroke/TIA and DM increases the incidence of stroke in participants with HF without AF. No analyzed subgroup had a stroke rate high enough to make it likely that the benefits of warfarin would outweigh the risks.

KW - Heart failure

KW - stroke

KW - warfarin

UR - http://www.scopus.com/inward/record.url?scp=84879705749&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84879705749&partnerID=8YFLogxK

U2 - 10.1016/j.jstrokecerebrovasdis.2011.10.012

DO - 10.1016/j.jstrokecerebrovasdis.2011.10.012

M3 - Article

C2 - 22142776

AN - SCOPUS:84879705749

VL - 22

SP - 620

EP - 626

JO - Journal of Stroke and Cerebrovascular Diseases

JF - Journal of Stroke and Cerebrovascular Diseases

SN - 1052-3057

IS - 5

ER -