Background:Whether ischemic stroke per se, rather than older age or additional comorbidities, accounts for the adverse prognosis of heart failure (HF) is uncertain. The present study examineed the intrinsic association of ischemic stroke with outcomes in a propensity-matched cohort.

Methods and Results:Of 1,351 patients hospitalized with HF, 388 (28.7%) had prior ischemic stroke. Using propensity score for prior ischemic stroke, estimated for each patient, a matched cohort of 379 pairs of HF patients with and without prior ischemic stroke, balanced on 32 baseline characteristics was assembled. At 30 days, prior ischemic stroke was associated with significantly higher risks of the combined endpoint of all-cause death or readmission (hazard ratio [HR]: 1.91; 95% confidence interval [CI]: 1.38 to 2.65; P<0.001), all-cause death (HR: 2.08; 95% CI: 1.28 to 3.38; P=0.003), all-cause readmission (HR: 2.67; 95% CI: 1.78 to 4.01; P<0.001), and HF readmission (HR: 2.11; 95% CI: 1.19 to 3.72; P=0.010). Prior ischemic stroke was associated with a significantly higher risk of all 4 outcomes at both 6 months and 1 year.

Conclusions:Prior ischemic stroke was a potent and persistent risk predictor of death and readmission among patients with HF after accounting for clinical characteristics.

背景：缺血性中风本身，而不是年龄或其他合并症，是心力衰竭（HF）不良预后的原因，尚不确定。本研究在倾向匹配的队列中研究了缺血性卒中与预后的内在联系。

方法和结果：在住院的HF患者1,351名中，有388名（28.7％）患有先前的缺血性中风。使用针对每个患者的先前缺血性卒中倾向评分，估算了379对有和没有先前缺血性卒中的HF患者的匹配队列，并在32个基线特征上取得了平衡。在第30天，先前的缺血性卒中与全因死亡或再入院的综合终点风险显着相关（危险比[HR]：1.91； 95％置信区间[CI]：1.38至2.65； P <0.001），全因死亡（HR：2.08; 95％CI：1.28至3.38; P = 0.003），全因再入院（HR：2.67; 95％CI：1.78至4.01; P <0.001）和HF再入院（HR： 2.11； 95％CI：1.19至3.72； P = 0.010）。在6个月和1年中，先前的缺血性中风与所有4种预后的风险显着相关。

结论：考虑到临床特征后，先前的缺血性卒中是HF患者死亡和再入院的有效和持久的危险指标。