title: Rheumatic Mitral Valve Disease Is Associated With Worse Outcomes in Stroke: A Thailand National Database Study.
abstract: OBJECTIVE
  Rheumatic valvular heart disease is associated with the increased risk of cerebrovascular events, although there are limited data on the prognosis of patients with rheumatic mitral valve disease (RMVD) after stroke.
  
  
  METHODS
  We examined the association between RMVD and both serious and common cardiovascular and noncardiovascular (respiratory and infective) complications in a cohort of hospitalized stroke patients based in Thailand. Factors associated with in-hospital mortality were also explored. Data were obtained from a National Insurance Database. All hospitalized strokes between October 1, 2004, and January 31, 2013, were included in the current study. Characteristics and outcomes were compared for RMVD and non-RMVD patients. Logistic regression, propensity score matching, and multivariate models were used to assess study outcomes.
  
  
  RESULTS
  In total, 594 681 patients (mean [SD] age=64 [14.5] years) with a diagnosis of stroke (ischemic=306 154; hemorrhagic=195 392; undetermined=93 135) were included in this study, of whom 5461 had RMVD. Results from primary analyses showed that after ischemic stroke, and controlling for potential confounding covariates, RMVD was associated (P<0.001) with increased odds for cardiac arrest (odds ratio [95% confidence interval]=2.13 [1.68-2.70]), shock (2.13 [1.64-2.77]), arrhythmias (1.70 [1.21-2.39]), respiratory failure (2.09 [1.87-2.33]), pneumonia (2.00 [1.81-2.20]), and sepsis (1.39 [1.19-1.63]). In hemorrhagic stroke patients, RMVD was associated with increased odds (fully adjusted model) for respiratory failure (1.26 [1.01-1.57]), and in patients with undetermined stroke, RMVD was associated with increased odds (fully adjusted analyses) for shock (3.00 [1.46-6.14]), respiratory failure (2.70 [1.91-3.79]), and pneumonia (2.42 [1.88-3.11]).
  
  
  CONCLUSIONS
  RMVD is associated with the development of cardiac arrest, shock, arrhythmias, respiratory failure, pneumonia, and sepsis after acute stroke.
authors.affiliation: From the Epidemiology Group, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, United Kingdom (A.D.W., R.S.B., P.K.M.); Oxford University Hospitals NHS Trust, United Kingdom (G.S.M.); Norwich Medical School, University of East Anglia, Norwich, United Kingdom (A.B.C.); Neurology Division (S.T., K.K.) and Ambulatory Medicine Division (K.K., K.S., N.K.), Department of Medicine, Faculty of Medicine, Khon Kaen University, Thailand; North-eastern Stroke Research Group, Khon Kaen University, Thailand (ST, NK); Clinical Informatics, Department of Medicine, University of Cambridge, United Kingdom (J.H.B.-S.); Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom (M.M.); and Farr Institute, University of Manchester, United Kingdom (M.M.).
authors.forename: Adrian D
authors.initials: AD
authors.lastname: Wood
authors.affiliation: From the Epidemiology Group, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, United Kingdom (A.D.W., R.S.B., P.K.M.); Oxford University Hospitals NHS Trust, United Kingdom (G.S.M.); Norwich Medical School, University of East Anglia, Norwich, United Kingdom (A.B.C.); Neurology Division (S.T., K.K.) and Ambulatory Medicine Division (K.K., K.S., N.K.), Department of Medicine, Faculty of Medicine, Khon Kaen University, Thailand; North-eastern Stroke Research Group, Khon Kaen University, Thailand (ST, NK); Clinical Informatics, Department of Medicine, University of Cambridge, United Kingdom (J.H.B.-S.); Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom (M.M.); and Farr Institute, University of Manchester, United Kingdom (M.M.).
authors.forename: Gurdeep S
authors.initials: GS
authors.lastname: Mannu
authors.affiliation: From the Epidemiology Group, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, United Kingdom (A.D.W., R.S.B., P.K.M.); Oxford University Hospitals NHS Trust, United Kingdom (G.S.M.); Norwich Medical School, University of East Anglia, Norwich, United Kingdom (A.B.C.); Neurology Division (S.T., K.K.) and Ambulatory Medicine Division (K.K., K.S., N.K.), Department of Medicine, Faculty of Medicine, Khon Kaen University, Thailand; North-eastern Stroke Research Group, Khon Kaen University, Thailand (ST, NK); Clinical Informatics, Department of Medicine, University of Cambridge, United Kingdom (J.H.B.-S.); Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom (M.M.); and Farr Institute, University of Manchester, United Kingdom (M.M.).
authors.forename: Allan B
authors.initials: AB
authors.lastname: Clark
authors.affiliation: From the Epidemiology Group, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, United Kingdom (A.D.W., R.S.B., P.K.M.); Oxford University Hospitals NHS Trust, United Kingdom (G.S.M.); Norwich Medical School, University of East Anglia, Norwich, United Kingdom (A.B.C.); Neurology Division (S.T., K.K.) and Ambulatory Medicine Division (K.K., K.S., N.K.), Department of Medicine, Faculty of Medicine, Khon Kaen University, Thailand; North-eastern Stroke Research Group, Khon Kaen University, Thailand (ST, NK); Clinical Informatics, Department of Medicine, University of Cambridge, United Kingdom (J.H.B.-S.); Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom (M.M.); and Farr Institute, University of Manchester, United Kingdom (M.M.).
authors.forename: Somsak
authors.initials: S
authors.lastname: Tiamkao
authors.affiliation: From the Epidemiology Group, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, United Kingdom (A.D.W., R.S.B., P.K.M.); Oxford University Hospitals NHS Trust, United Kingdom (G.S.M.); Norwich Medical School, University of East Anglia, Norwich, United Kingdom (A.B.C.); Neurology Division (S.T., K.K.) and Ambulatory Medicine Division (K.K., K.S., N.K.), Department of Medicine, Faculty of Medicine, Khon Kaen University, Thailand; North-eastern Stroke Research Group, Khon Kaen University, Thailand (ST, NK); Clinical Informatics, Department of Medicine, University of Cambridge, United Kingdom (J.H.B.-S.); Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom (M.M.); and Farr Institute, University of Manchester, United Kingdom (M.M.).
authors.forename: Kannikar
authors.initials: K
authors.lastname: Kongbunkiat
authors.affiliation: From the Epidemiology Group, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, United Kingdom (A.D.W., R.S.B., P.K.M.); Oxford University Hospitals NHS Trust, United Kingdom (G.S.M.); Norwich Medical School, University of East Anglia, Norwich, United Kingdom (A.B.C.); Neurology Division (S.T., K.K.) and Ambulatory Medicine Division (K.K., K.S., N.K.), Department of Medicine, Faculty of Medicine, Khon Kaen University, Thailand; North-eastern Stroke Research Group, Khon Kaen University, Thailand (ST, NK); Clinical Informatics, Department of Medicine, University of Cambridge, United Kingdom (J.H.B.-S.); Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom (M.M.); and Farr Institute, University of Manchester, United Kingdom (M.M.).
authors.forename: Joao H
authors.initials: JH
authors.lastname: Bettencourt-Silva
authors.affiliation: From the Epidemiology Group, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, United Kingdom (A.D.W., R.S.B., P.K.M.); Oxford University Hospitals NHS Trust, United Kingdom (G.S.M.); Norwich Medical School, University of East Anglia, Norwich, United Kingdom (A.B.C.); Neurology Division (S.T., K.K.) and Ambulatory Medicine Division (K.K., K.S., N.K.), Department of Medicine, Faculty of Medicine, Khon Kaen University, Thailand; North-eastern Stroke Research Group, Khon Kaen University, Thailand (ST, NK); Clinical Informatics, Department of Medicine, University of Cambridge, United Kingdom (J.H.B.-S.); Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom (M.M.); and Farr Institute, University of Manchester, United Kingdom (M.M.).
authors.forename: Kittisak
authors.initials: K
authors.lastname: Sawanyawisuth
authors.affiliation: From the Epidemiology Group, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, United Kingdom (A.D.W., R.S.B., P.K.M.); Oxford University Hospitals NHS Trust, United Kingdom (G.S.M.); Norwich Medical School, University of East Anglia, Norwich, United Kingdom (A.B.C.); Neurology Division (S.T., K.K.) and Ambulatory Medicine Division (K.K., K.S., N.K.), Department of Medicine, Faculty of Medicine, Khon Kaen University, Thailand; North-eastern Stroke Research Group, Khon Kaen University, Thailand (ST, NK); Clinical Informatics, Department of Medicine, University of Cambridge, United Kingdom (J.H.B.-S.); Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom (M.M.); and Farr Institute, University of Manchester, United Kingdom (M.M.).
authors.forename: Narongrit
authors.initials: N
authors.lastname: Kasemsap
authors.affiliation: From the Epidemiology Group, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, United Kingdom (A.D.W., R.S.B., P.K.M.); Oxford University Hospitals NHS Trust, United Kingdom (G.S.M.); Norwich Medical School, University of East Anglia, Norwich, United Kingdom (A.B.C.); Neurology Division (S.T., K.K.) and Ambulatory Medicine Division (K.K., K.S., N.K.), Department of Medicine, Faculty of Medicine, Khon Kaen University, Thailand; North-eastern Stroke Research Group, Khon Kaen University, Thailand (ST, NK); Clinical Informatics, Department of Medicine, University of Cambridge, United Kingdom (J.H.B.-S.); Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom (M.M.); and Farr Institute, University of Manchester, United Kingdom (M.M.).
authors.forename: Raphae S
authors.initials: RS
authors.lastname: Barlas
authors.affiliation: From the Epidemiology Group, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, United Kingdom (A.D.W., R.S.B., P.K.M.); Oxford University Hospitals NHS Trust, United Kingdom (G.S.M.); Norwich Medical School, University of East Anglia, Norwich, United Kingdom (A.B.C.); Neurology Division (S.T., K.K.) and Ambulatory Medicine Division (K.K., K.S., N.K.), Department of Medicine, Faculty of Medicine, Khon Kaen University, Thailand; North-eastern Stroke Research Group, Khon Kaen University, Thailand (ST, NK); Clinical Informatics, Department of Medicine, University of Cambridge, United Kingdom (J.H.B.-S.); Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom (M.M.); and Farr Institute, University of Manchester, United Kingdom (M.M.).
authors.forename: Mamas
authors.initials: M
authors.lastname: Mamas
authors.affiliation: From the Epidemiology Group, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, United Kingdom (A.D.W., R.S.B., P.K.M.); Oxford University Hospitals NHS Trust, United Kingdom (G.S.M.); Norwich Medical School, University of East Anglia, Norwich, United Kingdom (A.B.C.); Neurology Division (S.T., K.K.) and Ambulatory Medicine Division (K.K., K.S., N.K.), Department of Medicine, Faculty of Medicine, Khon Kaen University, Thailand; North-eastern Stroke Research Group, Khon Kaen University, Thailand (ST, NK); Clinical Informatics, Department of Medicine, University of Cambridge, United Kingdom (J.H.B.-S.); Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom (M.M.); and Farr Institute, University of Manchester, United Kingdom (M.M.). phyo.myint@abdn.ac.uk.
authors.forename: Phyo Kyaw
authors.initials: PK
authors.lastname: Myint
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000453:epidemiology / Q000209:etiology; D002545:Brain Ischemia / Q000150:complications / Q000453:epidemiology*; D002543:Cerebral Hemorrhage / Q000150:complications / Q000453:epidemiology*; D016208:Databases, Factual / Q000706:statistics & numerical data; D005260:Female; D006323:Heart Arrest / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000453:epidemiology*; D008946:Mitral Valve Stenosis / Q000453:epidemiology*; D009313:National Health Programs / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D011014:Pneumonia / Q000453:epidemiology / Q000209:etiology; D012131:Respiratory Insufficiency / Q000453:epidemiology / Q000209:etiology; D012214:Rheumatic Heart Disease; D018805:Sepsis / Q000453:epidemiology / Q000209:etiology; D012769:Shock / Q000453:epidemiology / Q000209:etiology; D020521:Stroke / Q000150:complications* / Q000453:epidemiology* / Q000209:etiology; D013785:Thailand / Q000453:epidemiology
keywords: complications; epidemiology; mortality; rheumatic heart disease; stroke