Decompensated Heart Failure Is a Strong Independent Predictor of Functional Outcome After Ischemic Stroke

Abstract

Background: Up to 24% of stroke patients have chronic heart failure. The aim of this study was to determine the frequency and prognostic significance of decompensated heart failure (DHF) in acute stroke patients.

Methods and results: Five hundred sixty-six patients (median age 73 y, 48% men) admitted to the stroke unit within 24 hours after stroke were prospectively included. Diagnosis of DHF was made by a cardiologist during hospitalization. Function outcome was assessed 1 month after stroke onset with the use of a modified Rankin Scale. Unfavorable outcome was defined as scores 3-6. DHF was diagnosed in 17% of patients. Fifty-seven percent of patients with DHF had preserved ejection fraction. Patients with DHF were older and more often female and more frequently suffered from hypertension, diabetes mellitus, atrial fibrillation, and myocardial infarction. They also had more severe neurologic deficit and more often had hyperglycemia, leukocytosis, fever, pneumonia, and renal failure. After multivariate analysis, adjusting for age, stroke severity, atrial fibrillation, myocardial infarction, hyperglycemia, pneumonia, fever, leukocytosis, proteinuria, and reduced ejection fraction, DHF remained an independent predictor of worse outcome (odds ratio 2.34, 95% CI 1.12-4.89; P = .02).

Conclusions: DHF is a strong independent predictor of poor functional prognosis after ischemic stroke.

Keywords: Stroke; ejection fraction; heart failure; outcome.