Risk of Stroke in Chronic Heart Failure Patients without Atrial Fibrillation: Analysis of the CORONA and GISSI-HF Trials
Background—Our aim was to describe the incidence and predictors of stroke in heart failure (HF) patients without atrial fibrillation (AF).
Methods and Results—We pooled two contemporary HF trials, the Controlled Rosuvastatin in Multinational Trial Heart Failure (CORONA) and the Gruppo Italiano per lo Studio della Sopravvivenza nell'Insufficienza cardiac- Heart Failure trial (GISSI-HF). Of the 9585 total patients, 6054 did not have AF. Stroke occurred in 165 patients (4.7%) with and in 206 patients (3.4%) without AF (rates 16.8 per 1000 patient-years and 11.1 per 1000 patient-years, respectively). Using Cox proportional-hazards models, we identified the following independent predictors of stroke in patients without AF (ranked by chi-square value): age (hazard ratio [HR] 1.34, 95% CI 1.18-1.63 per 10 years), NYHA class (1.60, 1.21-2124 class III/IV vs II), diabetes treated with insulin (1.87, 1.22-2.88), body mass index (0.74, 0.60-0.91 per 5kg/m2 up to 30) and previous stroke (1.81, 1.19-2.74). N-terminal pro B-type natriuretic peptide (NT-proBNP, available in 2,632 patients) was also an independent predictor of stroke (HR 1.31, 1.11-1.57 per log unit) when added to this model. Using a risk-score formulated from these predictors, we found that patients in the upper third of risk had a rate of stroke that approximated to the risk in patients with AF.
Conclusions—A small number of demographic and clinical variables identified a subset of HF patients without AF at high risk of stroke.
- Received October 22, 2014.
- Revision received January 21, 2015.
- Accepted February 26, 2015.