Stroke and mortality in patients with incident heart failure: the Diet, Cancer and Health (DCH) cohort study
- Gregory Y H Lip1,2,
- Lars Hvilsted Rasmussen2,3,
- Flemming Skjøth2,3,
- Kim Overvad3,4,
- Torben Bjerregaard Larsen2,3
- 1Centre for Cardiovascular Sciences, University of Birmingham, City Hospital, Birmingham, UK
- 2Thrombosis Research Centre, Clinical Institute, Faculty of Health, Aalborg University, Denmark
- 3Department of Cardiology, Aalborg AF Study Group, Cardiovascular Research Centre, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark
- 4School of Public Health, Aarhus University, Aarhus, Denmark
- Correspondence to Professor Gregory Y H Lip;
- Received 22 March 2012
- Accepted 15 May 2012
- Published 7 July 2012
Objective The objective was to test the hypothesis that the risk of stroke, death and the composite of ‘stroke and death’ would be increased among patients with incident heart failure (HF). While HF increases the risk of mortality, stroke and thromboembolism in general, the ‘extreme high-risk’ nature of incident HF is perhaps under-recognised in everyday clinical practice.
Design Prospective cohort study.
Setting Large Danish prospective epidemiological cohort.
Participants Subjects in the Diet, Cancer and Health study.
Outcome measures Stroke, death and the composite of ‘stroke and death’ among patients with incident cases of HF, without concomitant atrial fibrillation.
Results From the original cohort, 1239 patients with incident HF were identified. Incidence rates show a higher incidence in the initial period following the diagnosis of HF, with a markedly higher rate of death and stroke (ischaemic or haemorrhagic) in the initial 30 days following the diagnosis of incident HF. While lower than the risk at 0–30 days, the higher risk did not return to normal at 6+ months after the diagnosis of incident HF. This risk increase was apparent for the end points of stroke (ischaemic or haemorrhagic or both) whether or not a vitamin K antagonist (VKA) was used. With VKA use, there was a lower adjusted HR for death and the composite of ‘death or stroke’ compared to non-VKA use at the three time intervals following diagnosis of HF, whether 0–30 days, 30 days to 6 months and 6+ months. On multivariate analysis, previous stroke/transient ischaemic attack/thromboembolism was a predictor of higher risk of stroke, death and the composite of ‘stroke and death’, while VKA treatment was a highly significant predictor of a lower risk for death (adjusted HR 0.46, 95% CI 0.28 to 0.74, p<0.001) and the combined end point of death or stroke (adjusted HR 0.64, 95% CI 0.43 to 0.96, p=0.003).
Conclusions Based on relative hazards, incident HF is clearly a major risk factor for stroke, death and the composite of ‘stroke and death’, especially in the initial 30 days following initial diagnosis. The use of VKA therapy was associated with a lower risk of these end points. These findings would have major implications for the approach to management of patients presenting with incident HF, given the high risk of this population for death and stroke, which may be ameliorated by VKA therapy.
To cite: Lip GYH, Rasmussen LH, Skjøth F, et al. Stroke and mortality in patients with incident heart failure: the Diet, Cancer and Health (DCH) cohort study. BMJ Open 2012;2:e000975. doi:10.1136/bmjopen-2012-000975
Contributors GL—study hypothesis, data interpretation, drafting and revision of the manuscript. FS—data analysis, drafting and revision of the manuscript. LHR, KO and TBL—data interpretation, drafting and revision of the manuscript.
Funding The Danish Cancer Society financed the establishment of Diet, Cancer and Health.
Competing interests None.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement No additional data available.
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