UK Biobank: na ischemisch CVA of TIA is het risico op hartfalen groter dan dat op een infarct

Aims: To define incident heart failure (HF) risk in ischaemic stroke/TIA survivors. Secondary aims: to define the association of HF with all-cause mortality in stroke survivors and to describe their cardiac magnetic resonance findings. Methods: Prospective cohort study using the UK Biobank cohort (aged 40–69 years), excluding individuals with prior HF. Participants were stratified by history of ischaemic stroke/TIA. Main outcome: incident HF as defined by hospital admissions coded for HF. Secondary outcomes: all-cause mortality, myocardial infarction and CMR findings. Results: 405,406 individuals were included (mean age 56.5 years, 45.6% males). Over 13.7 years of follow-up, 15,565 individuals developed incident HF. Stroke/TIA survivors had a crude HR 3.6 (95% CI 3.3–3.8; p<0.0001) for HF hospitalization, attenuated to adjusted HR 1.4 (95% CI 1.3–1.5; p<0.0001). The risk of HF hospitalization exceeded the risk of MI (12.6% vs 5.4%). Stroke survivors with subsequent HF had lower LVEF and higher LV mass on CMR than those without HF. Incident HF after stroke was associated with HR 1.8 (95% CI 1.6–1.9) for mortality. Conclusions: Incident HF is common in stroke survivors and strongly associates with mortality. The risk of HF exceeds the risk of subsequent MI — a counter-intuitive finding that argues for systematic cardiac follow-up of stroke survivors with structured HF risk assessment.