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Accepted (AM)Open Access (License Unspecified), Open
Journal article
Identifying a High Stroke Risk Subgroup in Individuals with Heart Failure
Journal of stroke and cerebrovascular diseases, v 22(5), pp 620-626
01 Jul 2013
PMID: 22142776
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Background: Heart failure (HF) is associated with an overall stroke rate that is too low to justify anticoagulation in all patients. This study was conducted to determine if vascular risk factors can identify a subgroup of individuals with heart failure with a stroke rate high enough to warrant anticoagulation. Methods: The REGARDS study is a population-based cohort of US adults aged >= 45 years. Participants are contacted every 6 months by telephone for self-or proxy-reported stroke and medical records are retrieved and adjudicated by physicians. Participants were characterized into 3 groups: HF without atrial fibrillation (AF), AF with or without HF, and neither HF nor AF. Cardiovascular risk factors at baseline were compared between participants with and without incident stroke in HF and AF. Stroke incidence was assessed in risk factor subgroups in HF participants. Results: Of the 30,239 participants, those with missing/anomalous data were excluded. Of the remaining 28,832, 1360 (5%) had HF without AF, 2528 (9%) had AF, and 24,944 (86%) had neither. Previous stroke/transient ischemic attack (TIA; P = .0004), diabetes mellitus (DM; P = .03), and higher systolic blood pressure (P = .046) were associated with increased stroke risk in participants with HF without AF. In participants with HF without AF, stroke incidence was highest in those with previous stroke/TIA and DM (2.4 [1.1, 4.0] per 100 person-years). Conclusions: The combination of previous stroke/TIA and DM increases the incidence of stroke in participants with HF without AF. No analyzed subgroup had a stroke rate high enough to make it likely that the benefits of warfarin would outweigh the risks.
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Details
- Title
- Identifying a High Stroke Risk Subgroup in Individuals with Heart Failure
- Creators
- Patrick M. Pullicino - University of KentLeslie A. McClure - University of Alabama at BirminghamVirginia J. Howard - University of Alabama at BirminghamVirginia G. Wadley - University of Alabama at BirminghamMonika M. Safford - University of Alabama at BirminghamJames F. Meschia - Jacksonville CollegeAaron Anderson - Emory UniversityGeorge Howard - University of Alabama at BirminghamElsayed Z. Soliman - Wake Forest University
- Publication Details
- Journal of stroke and cerebrovascular diseases, v 22(5), pp 620-626
- Publisher
- Elsevier
- Number of pages
- 7
- Grant note
- U01 NS041588 / National Institute of Neurological Disorders and Stroke, National Institutes of Health, Department of Health and Human Service; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of Neurological Disorders & Stroke (NINDS) U01NS041588 / NATIONAL INSTITUTE OF NEUROLOGICAL DISORDERS AND STROKE; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of Neurological Disorders & Stroke (NINDS)
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Epidemiology and Biostatistics
- Web of Science ID
- WOS:000321550000005
- Scopus ID
- 2-s2.0-84879705749
- Other Identifier
- 991019231634604721
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- Collaboration types
- Domestic collaboration
- International collaboration
- Web of Science research areas
- Neurosciences
- Peripheral Vascular Disease