title: Long-term prognosis of combined chronic heart failure and chronic renal dysfunction after acute stroke.
abstract: OBJECTIVE
  To assess the prevalence of combined chronic heart failure and chronic renal dysfunction (CHF-CRD) in acute stroke patients and to investigate any prognostic significance on long-term outcome.
  
  
  RESULTS
  First-ever acute stroke patients (n = 831) were divided into four groups based on the presence of heart failure (HF, NYHA II-IV with or without left ventricular ejection fraction <40%) and/or renal dysfunction (RD, estimated glomerular filtration rate <60 mL/min/1.73 m(2)). Patients with acute kidney injury and/or acute decompensated HF were excluded. Group 1 comprised patients without HF or RD (nHF + nRD), Group 2 patients with RD but no HF (nHF + RD), Group 3 those with HF and no RD (HF + nRD), whereas Group 4 included patients with both HF and RD (HF + RD). HF and RD were independent predictors of mortality at 10 years. Patients in Groups 2, 3, and 4 had an increased probability of death during follow-up compared with Group 1: HR 1.34 (95% CI 1.02-1.77, P < 0.05) for group 2; HR 2.24 (95% CI 1.50-3.36, P < 0.001) for group 3; and HR 3.42 (95% CI 2.36-4.95, P < 0.001) for group 4. Age, history of transient ischaemic attacks and combined HF and RD were independent predictors of new cardiovascular events. When compared with Group 1, patients in Group 2 had an HR of 1.48 (95% CI 1.11-1.98, P < 0.01), those in Group 3 an HR of 2.21 (95% CI 1.48-3.29, P < 0.001), and those in Group 4 an HR of 3.59 (95% CI 2.40-5.39, P < 0.001).
  
  
  CONCLUSIONS
  The combination of CHF-CRD after acute stroke is an independent predictor for mortality and new cardiovascular morbidity over 10 years.
authors.affiliation: Renal Unit, Alexandra Hospital, Athens, Greece. tsagalis@otenet.gr
authors.forename: George
authors.initials: G
authors.lastname: Tsagalis
authors.forename: Neratzoula
authors.initials: N
authors.lastname: Bakirtzi
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Spengos
authors.forename: Anastasia
authors.initials: A
authors.lastname: Vemmou
authors.forename: Efstathios
authors.initials: E
authors.lastname: Manios
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Xinos
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Vemmos
mesh_terms: D000208:Acute Disease; D000368:Aged; D015897:Comorbidity; D016001:Confidence Intervals; D018450:Disease Progression; D005260:Female; D006115:Greece / Q000453:epidemiology; D006305:Health Status Indicators; D006331:Heart Diseases / Q000209:etiology; D006333:Heart Failure / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D013223:Statistics as Topic; D020521:Stroke / Q000150:complications* / Q000503:physiopathology; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left