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. 2025 Mar;10(1):100-107.
doi: 10.1177/23969873241264115. Epub 2024 Jul 30.

Stroke-heart syndrome: Incidence and clinical outcomes of cardiac complications following intracerebral haemorrhage

Katie L Hoad  1   2 , Helen Jones  1   2 , Gemma Miller  2 , Azmil H Abdul-Rahim  1   3   4 , Gregory Yh Lip  1   5 , Benjamin Jr Buckley  1   2
Affiliations

Stroke-heart syndrome: Incidence and clinical outcomes of cardiac complications following intracerebral haemorrhage

Katie L Hoad et al. Eur Stroke J. 2025 Mar.

Abstract

Introduction: Newly diagnosed cardiovascular complications following an ischaemic stroke, termed stroke-heart syndrome, are common and associated with worse outcomes. Little is known regarding stroke-heart syndrome in relation to intracerebral haemorrhage (ICH). This study aimed to investigate the incidence and 5-year major adverse cardiovascular events (MACE; acute myocardial infarction, ischaemic stroke, all-cause mortality and recurrent ICH) of newly diagnosed cardiovascular complications following incident ICH, using a global federated database.

Patients and methods: A retrospective cohort study was conducted using anonymised electronic medical records. Patients aged ⩾ 18 years with non-traumatic ICH and 5-year follow-up were included. Patients with newly diagnosed cardiovascular complications within 4-weeks following the initial ICH were 1:1 propensity score-matched with patients without new-onset cardiovascular complications. Each cardiovascular complications were investigated as a composite stroke-heart syndrome cohort and separately for associated MACE. Cox hazard regression models were used to determine 5-year incidence of MACE.

Results: Before propensity score matching, 171,489 patients with non-traumatic ICH, 15% (n = 26,449) experienced ⩾1 newly diagnosed cardiovascular complication within 4 weeks. After matching, patients with ICH and cardiovascular complications were associated with a significantly higher risk of 5-year MACE (HR 1.35 [95% CI 1.32-1.38]), and in each composite compared to matched controls. There was no significant risk of rehospitalisation over 5-year follow-up [HR 0.90 [0.73-1.13]). The risk of MACE was significantly higher in patients with newly diagnosed cardiovascular complications.

Discussion and conclusions: Newly diagnosed cardiovascular complications following ICH (i.e. stroke-heart syndrome) were common and associated with a significantly worsened 5-year prognosis.

Keywords: Stroke-heart syndrome; arrhythmias; heart failure; intracerebral haemorrhage; outcomes.

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Conflict of interest statement

Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: BB has received research funding from BMS/Pfizer. GYHL is a consultant and speaker for BMS/Pfizer, Boehringer Ingelheim, Daiichi-Sankyo, Anthos. No fees are received personally. He is a National Institute for Health and Care Research (NIHR) Senior Investigator and co-PI of the AFFIRMO project on multimorbidity in AF (grant agreement No. 899871), TARGET project on digital twins for personalised management of atrial fibrillation and stroke (grant agreement No. 101136244) and ARISTOTELES project on artificial intelligence for management of chronic long term conditions (grant agreement No. 101080189), which are all funded by the EU’s Horizon Europe Research & Innovation programme.

Figures

Graphical abstract
Graphical abstract
Figure 1.
Figure 1.
Hazard ratios and 95% confidence intervals for the risk of major adverse cardiovascular events over 5-year follow-up in patients with newly diagnosed cardiovascular complications versus those who were not newly diagnosed with a cardiovascular complications 4-weeks post intracerebral haemorrhagic stroke. CI: confidence interval; ICH: intracerebral haemorrhage; MACE: major adverse cardiovascular events. Hazard ratio (HR), through Cox regression models, reported for propensity-score matched cohort.
Figure 2.
Figure 2.
Hazard ratios and 95% confidence intervals for the risk of major adverse cardiovascular events over 5-year follow-up in patients with either atrial fibrillation/flutter, severe ventricular arrhythmias, heart failure, or ischaemic heart diseases versus those who did not have newly diagnosed cardiovascular complications 4-weeks post intracerebral haemorrhagic stroke. CI: confidence interval; ICH: intracerebral haemorrhage; MACE: major adverse cardiovascular events. Hazard ratio (HR), through Cox regression models, reported for propensity-score matched cohort.
Figure 3.
Figure 3.
Hazard ratios and 95% confidence intervals for the risk of each major adverse cardiovascular events composites (all-cause mortality, ischaemic stroke, recurrent intracerebral haemorrhage, acute myocardial infarction, rehospitalisation) over 5-year follow-up in patients with either atrial fibrillation/flutter, severe ventricular arrhythmias, heart failure, or ischaemic heart diseases versus those who did not have newly diagnosed cardiovascular complications 4-weeks post intracerebral haemorrhagic stroke. CI: confidence interval; ICH: intracerebral haemorrhage; MACE: major adverse cardiovascular events. Hazard ratio (HR), through Cox regression models, reported for propensity-score matched cohort.
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