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Risk of Stroke in Chronic Heart Failure Patients Without Atrial Fibrillation: Analysis of the Controlled Rosuvastatin in Multinational Trial Heart Failure (CORONA) and the Gruppo Italiano per lo Studio della Sopravvivenza nell'Insufficienza Cardiaca-Heart Failure (GISSI-HF) Trials.

From Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (A.H.A.-R., A.-C.P., R.L.F., P.S.J., K.R.L., J.J.V.M.); IRCCS-RL: Istituto Mario Negri, Milan, Italy (R.L.); Consorzio Mario Negri Sud, S Maria Imbaro, Italy (G.T.); Sahlgrenska Academy, Gothenburg University, Sweden (J.W.); Rikshospitalet University Hospital, Oslo, Norway (J.K.); University of Birmingham, Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark (G.Y.H.L.); ANMCO Research Center, Florence, Italy (A.P.M.); and Maria Cecilia Hospital, GVM Care&Research - E.S. Health Science Foundation, Cotignola, Italy (L.T.). From Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (A.H.A.-R., A.-C.P., R.L.F., P.S.J., K.R.L., J.J.V.M.); IRCCS-RL: Istituto Mario Negri, Milan, Italy (R.L.); Consorzio Mario Negri Sud, S Maria Imbaro, Italy (G.T.); Sahlgrenska Academy, Gothenburg University, Sweden (J.W.); Rikshospitalet University Hospital, Oslo, Norway (J.K.); University of Birmingham, Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark (G.Y.H.L.); ANMCO Research Center, Florence, Italy (A.P.M.); and Maria Cecilia Hospital, GVM Care&Research - E.S. Health Science Foundation, Cotignola, Italy (L.T.). john.mcmurray@glasgow.ac.uk.

Circulation. 2015;(17):1486-94; discussion 1494
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Abstract

BACKGROUND Our aim was to describe the incidence and predictors of stroke in patients who have heart failure without atrial fibrillation (AF). METHODS AND RESULTS We pooled 2 contemporary heart failure trials, the Controlled Rosuvastatin in Multinational Trial Heart Failure (CORONA) and the Gruppo Italiano per lo Studio della Sopravvivenza nell'Insufficienza cardiaca-Heart Failure trial (GISSI-HF). Of the 9585 total patients, 6054 did not have AF. Stroke occurred in 165 patients (4.7%) with AF and in 206 patients (3.4%) without AF (rates 16.8/1000 patient-years and 11.1/1000 patient-years, respectively). Using Cox proportional-hazards models, we identified the following independent predictors of stroke in patients without AF (ranked by χ(2) value): age (hazard ratio, 1.34; 95% confidence interval, 1.18-1.63 per 10 years), New York Heart Association class (1.60, 1.21-2.12 class III/IV versus II), diabetes mellitus treated with insulin (1.87, 1.22-2.88), body mass index (0.74, 0.60-0.91 per 5 kg/m(2) up to 30), and previous stroke (1.81, 1.19-2.74). N-terminal pro B-type natriuretic peptide (available in 2632 patients) was also an independent predictor of stroke (hazard ratio, 1.31; 1.11-1.57 per log unit) when added to this model. With the use of a risk score formulated from these predictors, we found that patients in the upper third of risk had a rate of stroke that approximated the risk in patients with AF. CONCLUSIONS A small number of demographic and clinical variables identified a subset of patients who have heart failure without AF at a high risk of stroke.

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Publication Type : Meta-Analysis

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