title: Ischemic stroke history predicts increased cardiovascular mortality in chronic heart failure.
abstract: OBJECTIVE
  To investigate comorbidities that predict cardiac mortality and re-hospitalization in chronic heart failure (CHF) patients.
  
  
  METHODS
  Five hundred eighty patients (mean age 63 ± 13 years, 373 male, 207 female, mean ejection fraction (EF) 26 ± 9%) with mild, moderate or severe CHF [NYHA class II-IV] were included in this prospective observational study. We evaluated all comorbidities such as history of ischemic stroke, coronary artery disease, peripheral arterial disease, chronic obstructive lung disease, hypertension, diabetes mellitus and chronic kidney disease in CHF patients who were hospitalized due to decompensated heart failure in Kocaeli University, Faculty of Medicine's Hospital between January 2003 and July 2009. Cox regression and Kaplan-Meier survival analyses were used to establish predictors of unfavorable outcomes.
  
  
  RESULTS
  Of 580 patients 207 (36%) patients died due to cardiovascular reasons. In multivariable Cox regression analysis age (HR-1.06, 95% CI 1.04-1.08, p<0.001), NYHA functional class (HR-3.20 95% CI, 1.90-5.41, p<0.001), history of ischemic stroke (HR-2.48, 95% CI 1.14-5.37, p=0.022), high-sensitive C-reactive protein (HR-1.09, 95% CI, 1.04-1.15, p=0.001), brain natriuretic peptide (HR-1.00, 95% CI 1.00-1.00, p=0.01) and hemoglobin (HR-0.90, 95% CI 0.81-0.99, p=0.038) were independent predictors of cardiac death in the present study. History of ischemic stroke was demonstrated as an important comorbidity that predicts cardiovascular mortality beyond other co-morbidities in CHF patients. NYHA functional class (HR-2.85, 95% CI 1.80-4.65, p<0.001), left ventricular EF [(HR-0.98, 95% CI 0.95-0.99, p=0.039) and ischemic stroke history (HR-2.41, 95% CI 1.15-5.05, p=0.019) were independent predictors for recurrence hospitalization. The stroke history was only predictor showing recurrent hospitalization at least in one year among the other comorbid conditions, which were evaluated during study.
  
  
  CONCLUSIONS
  History of ischemic stroke may be an important risk factor for increased cardiac mortality and recurrence hospitalization in CHF patients.
authors.affiliation: Department of Cardiology, Faculty of Medicine, Kocaeli University, Kocaeli-Turkey.
authors.forename: Güliz
authors.initials: G
authors.lastname: Kozdağ
authors.forename: Mehmet
authors.initials: M
authors.lastname: Yaymacı
authors.forename: Pervin
authors.initials: P
authors.lastname: Işeri
authors.forename: Gökhan
authors.initials: G
authors.lastname: Ertaş
authors.forename: Ender
authors.initials: E
authors.lastname: Emre
authors.forename: Ulaş
authors.initials: U
authors.lastname: Bildirici
authors.forename: Teoman
authors.initials: T
authors.lastname: Kılıç
authors.forename: Dilek
authors.initials: D
authors.lastname: Ural
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000150:complications* / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000150:complications / Q000453:epidemiology / Q000401:mortality*; D002908:Chronic Disease; D015897:Comorbidity; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000453:epidemiology / Q000401:mortality; D006454:Hemoglobins / Q000032:analysis; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000150:complications* / Q000453:epidemiology; D014421:Turkey / Q000453:epidemiology
chemical_list: D006454:Hemoglobins; D020097:Natriuretic Peptide, Brain