Revascularisation therapies improve the outcomes of ischemic stroke patients with atrial fibrillation and heart failure. (1st February 2021)

• Record Type: Journal Article
• Authors: Pana, Tiberiu A.; Mohamed, Mohamed O.; Clark, Allan B.; Fahy, Eoin; Mamas, Mamas A.; Myint, Phyo K.
• Is Part Of: International journal of cardiology. Volume 324(2021)
• Page Start: 205
• Page End: 213
• Publication Date: 2021-02-01
• Subjects: Atrial fibrillation -- Heart failure -- Cerebrovascular disease -- Stroke -- Thrombolysis -- Thrombectomy; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2020.09.076
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: Atrial fibrillation (AF) and heart failure (HF) carry a poor prognosis in acute ischaemic stroke (AIS). The impact of revascularisation therapies on outcomes in these patients is not fully understood. Method: National Inpatient Sample (NIS) AIS admissions (January 2004–September 2015) were included ( n = 4, 597, 428). Logistic regressions analysed the relationship between exposures (neither AF nor HF-reference, AF-only, HF-only, AF + HF) and outcomes (in-hospital mortality, length-of-stay >median and moderate-to-severe disability on discharge), stratifying by receipt of intravenous thrombolysis (IVT) or endovascular thrombectomy (ET). Results: 69.2% patients had neither AF nor HF, 16.5% had AF-only, 7.5% had HF-only and 6.7% had AF + HF. 5.04% and 0.72% patients underwent IVT and/or ET, respectively. AF-only and HF-only were each associated with 75–85% increase in the odds of in-hospital mortality. AF + HF was associated with greater than two-fold increase in mortality. Patients with AF-only, HF-only or AF + HF undergoing IVT had better or at least similar in-hospital outcomes compared to their counterparts not undergoing IVT, except for prolonged hospitalisation. Patients undergoing ET with AF-only, HF-only or AF + HF had better (in-hospital mortality, discharge disability, all-cause bleeding) or at least similar (length-of-stay) outcomes to their counterparts not undergoing ET. Compared to AIS patients without AF, AF patients had approximately 50% and more than two-fold increases in the likelihood of receiving IVT or ET, respectively. Conclusions: We confirmed the combined and individual impact of co-existing AF or HF on important patient-related outcomes. Revascularisation therapies improve these outcomes significantly in patients with these comorbidities. Highlights: The impact of IVT and ET on stroke outcomes in patients with AF and HF was assessed. Estimates were calculated for all US ischemic stroke admissions between 2004 and 2015. AF and HF were associated with significantly worse in-hospital outcomes. IVT/ET reduced the AF/HF-associated excess odds of adverse in-hospital outcomes. IVT/ET should be considered in ischemic stroke patients with AF/HF if not contraindicated.