Review ArticleThe Incidence of Ischemic Stroke in Chronic Heart Failure: A Meta-Analysis
Section snippets
Study Identification
Potential studies were identified by electronic search of the Medline and PubMed databases. Four separate searches were conducted during the week of January 24, 2005. All searches used the exploded terms “heart failure, congestive,” “ventricular dysfunction, left,” and “cardiac output, low” combined with the “or” operator. For the first search, the exploded terms “pacemaker, artificial,” “defibrillators, implantable,” “cardiac pacing, artificial,” and the text word “resynchronization” were
Search
Electronic database searches yielded 830 potential articles. Twenty-four of these met eligibility criteria; however, 4 reported on the same population and were excluded. Hand searching of the American College of Cardiology and American Heart Association meeting proceedings and the reference lists of the included articles yielded another 5 articles. An additional 11 studies reported stroke as part of a combined outcome. An attempt was made to contact the authors of these studies. One provided
Discussion
HF represents a growing public health problem.1 Despite advances in treatment, HF remains a highly fatal disease with mortality approaching 50% at 5 years.1, 2 Stroke more than doubles the risk of death among persons with HF.49 Thus stroke prevention in HF represents an opportunity to improve survival in this highly fatal disease. However, the true risk of stroke among persons with HF remains poorly defined because of differences in study design. Furthermore, predictors of stroke in HF are
Conclusions
The stroke rate among persons with HF is similar to that experienced among persons with AF who are not on anticoagulant therapy and is much higher than the stroke rate in the general population. Given the high mortality rate observed in HF, stroke prevention represents an opportunity to save many lives in this already highly fatal disease. Prospective studies are needed to clarify the risk of stroke among HF patients with AF and the risk of stroke at different levels of left ventricular
Acknowledgment
The authors thank Ryan Lennon, MS, and Jill Killian, BS, for assistance with statistical analyses, and Kristie Shorter for secretarial support.
References (57)
- et al.
ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines
J Am Coll Cardiol
(2006) - et al.
Prognostic usefulness of left ventricular thrombus by echocardiography in dilated cardiomyopathy in predicting stroke, transient ischemic attack, and death
Am J Cardiol
(2004) - et al.
Bisoprolol for the treatment of chronic heart failure: a meta-analysis on individual data of two placebo-controlled studies—CIBIS and CIBIS II. Cardiac Insufficiency Bisoprolol Study
Am Heart J
(2002) - et al.
Ejection fraction and risk of thromboembolic events in patients with systolic dysfunction and sinus rhythm: evidence for gender differences in the studies of left ventricular dysfunction trials
J Am Coll Cardiol
(1997) - et al.
The natural history of idiopathic dilated cardiomyopathy
Am J Cardiol
(1981) - et al.
Dilated cardiomyopathy with mitral regurgitation: decreased survival despite a low frequency of left ventricular thrombus
Am Heart J
(1991) - et al.
Frequency and embolic potential of left ventricular thrombus in dilated cardiomyopathy: assessment by 2-dimensional echocardiography
Am J Cardiol
(1983) - et al.
Ventricular thrombi and thromboembolism in dilated cardiomyopathy: a prospective follow-up study
Am Heart J
(1992) - et al.
Effect of mitral regurgitation on left ventricular thrombus formation in dilated cardiomyopathy
Am Heart J
(1998) - et al.
Risk of arterial embolization in 224 patients awaiting cardiac transplantation
Am Heart J
(1995)
Spectrum and outcome of congestive heart failure in a hospitalized population
Am Heart J
Low incidence of stroke in ambulatory patients with heart failure: a prospective study
Am Heart J
Left ventricular thrombus and subsequent thromboembolism in patients with severe systolic dysfunction
Chest
Long-term outcome in patients with congestive heart failure and intact systolic left ventricular performance
Am J Cardiol
Usefulness of physiologic dual-chamber pacing in drug-resistant idiopathic dilated cardiomyopathy
Am J Cardiol
Incidence, predictive factors, and prognostic significance of supraventricular tachyarrhythmias in congestive heart failure
Chest
The Warfarin/Aspirin Study in Heart failure (WASH): a randomized trial comparing antithrombotic strategies for patients with heart failure
Am Heart J
Effects of candesartan in patients with chronic heart failure and reduced left-ventricular systolic function intolerant to angiotensin-converting-enzyme inhibitors: the CHARM-Alternative trial
Lancet
Effects of candesartan in patients with chronic heart failure and reduced left-ventricular systolic function taking angiotensin-converting-enzyme inhibitors: the CHARM-Added trial
Lancet
Effect of losartan compared with captopril on mortality in patients with symptomatic heart failure: randomised trial—the Losartan Heart Failure Survival Study ELITE II
Lancet
Effects of candesartan on mortality and morbidity in patients with chronic heart failure: the CHARM-Overall programme
Lancet
Beneficial effects of metoprolol in idiopathic dilated cardiomyopathy
Lancet
The risk of ischemic stroke in heart failure: a population-based study in Olmsted County, Minnesota
Am Heart J
To anticoagulate or not to anticoagulate patients with cardiomyopathy
Cardiol Clin
ACC/AHA guidelines for the evaluation and management of chronic heart failure in the adult
J Am Coll Cardiol
Healthy volunteer effect in industrial workers
J Clin Epidemiol
Trends in heart failure incidence and survival in a community-based population
JAMA
Cited by (100)
Risk of Ischemic Stroke in Patients Newly Diagnosed With Heart Failure: Focus on Patients Without Atrial Fibrillation
2019, Journal of Cardiac FailureCitation Excerpt :Moreover, the difference in the risk of stroke observed between patients with HF and patients without HF increased over time from 1 percentage point at 12 months to 3 percentage point at 36 months (Kaplan-Meier rates of 5.9% vs 3.3%, P < .001). Although numerous studies support that the overall population of patients with HF,9,21 and particularly those with AF,22,23 are at higher risk of stroke, such evidence in patients with HF without AF is not as clear. For example, in the population-based Reasons for Geographic and Racial Differences in Stroke study, the rates of ischemic stroke reached 0.69 (95% CI 0.49–0.93) among patients with HF without AF, and 0.40 (95% CI 0.37–0.44) among patients with neither HF nor AF.22
Multimodal Cardiac Imaging in the Assessment of Patients Who Have Suffered a Cardioembolic Stroke: A Review
2024, Journal of Cardiovascular Development and Disease
Funded by grants AR30582, HL59205, and HL68765 from the Public Health Service, National Institutes of Health. Grant support used to fund data analysis.