title: Risk of Stroke in Patients With Heart Failure: A Population-Based 30-Year Cohort Study.
abstract: The long-term risk of specific stroke subtypes among heart failure patients is largely unknown. We examined short-term and long-term risk of ischemic stroke, intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH) in heart failure patients and in a general population comparison cohort.
  
  
  
  In this nationwide cohort study (1980-2012), we used Danish population-based medical registries to identify and follow (1) all patients hospitalized for the first time with heart failure and (2) a birth year-, sex-, and calendar year-matched general population comparison cohort. Age-, sex-, and comorbidity-adjusted stroke rate ratios were computed based on Cox regression analysis.
  
  
  
  We included 289 353 patients with heart failure and 1 446 765 individuals from the general population in the analysis. One- and 5-year risks among heart failure patients were 1.4% and 3.9% for ischemic stroke, 0.2% and 0.5% for ICH, and 0.03% and 0.07% for SAH. The 30-day adjusted stroke rate ratio was increased markedly for ischemic stroke (5.08; 95% confidence interval, 4.58-5.63] and was also elevated for ICH (2.13; 95% confidence interval, 1.53-2.97) and SAH (3.52; 95% confidence interval, 1.54-8.08). Between 31 days and 30 years, risk of all stroke subtypes remained positively associated with heart failure (1.5- to 2.1-fold for ischemic stroke, 1.4- to 1.8-fold for ICH, and 1.1- to 1.7-fold for SAH) in comparison with the general population cohort.
  
  
  
  Heart failure was associated with increased short-term and long-term risk of all stroke subtypes, suggesting that heart failure is a potent and persistent risk factor for ischemic stroke, ICH, and SAH.
authors.affiliation: From the Department of Clinical Epidemiology, Aarhus University Hospital, Denmark (K.A., S.S., J.S., E.H.-P., V.W.H., A.O., L.P., H.T.S.); and Department of Health Research and Policy (Epidemiology) (V.W.H., H.T.S.) and Department of Neurology and Neurological Sciences (V.W.H.), Stanford University, CA. kade@clin.au.dk.
authors.forename: Kasper
authors.initials: K
authors.lastname: Adelborg
authors.affiliation: From the Department of Clinical Epidemiology, Aarhus University Hospital, Denmark (K.A., S.S., J.S., E.H.-P., V.W.H., A.O., L.P., H.T.S.); and Department of Health Research and Policy (Epidemiology) (V.W.H., H.T.S.) and Department of Neurology and Neurological Sciences (V.W.H.), Stanford University, CA.
authors.forename: Szimonetta
authors.initials: S
authors.lastname: Szépligeti
authors.affiliation: From the Department of Clinical Epidemiology, Aarhus University Hospital, Denmark (K.A., S.S., J.S., E.H.-P., V.W.H., A.O., L.P., H.T.S.); and Department of Health Research and Policy (Epidemiology) (V.W.H., H.T.S.) and Department of Neurology and Neurological Sciences (V.W.H.), Stanford University, CA.
authors.forename: Jens
authors.initials: J
authors.lastname: Sundbøll
authors.affiliation: From the Department of Clinical Epidemiology, Aarhus University Hospital, Denmark (K.A., S.S., J.S., E.H.-P., V.W.H., A.O., L.P., H.T.S.); and Department of Health Research and Policy (Epidemiology) (V.W.H., H.T.S.) and Department of Neurology and Neurological Sciences (V.W.H.), Stanford University, CA.
authors.forename: Erzsébet
authors.initials: E
authors.lastname: Horváth-Puhó
authors.affiliation: From the Department of Clinical Epidemiology, Aarhus University Hospital, Denmark (K.A., S.S., J.S., E.H.-P., V.W.H., A.O., L.P., H.T.S.); and Department of Health Research and Policy (Epidemiology) (V.W.H., H.T.S.) and Department of Neurology and Neurological Sciences (V.W.H.), Stanford University, CA.
authors.forename: Victor W
authors.initials: VW
authors.lastname: Henderson
authors.affiliation: From the Department of Clinical Epidemiology, Aarhus University Hospital, Denmark (K.A., S.S., J.S., E.H.-P., V.W.H., A.O., L.P., H.T.S.); and Department of Health Research and Policy (Epidemiology) (V.W.H., H.T.S.) and Department of Neurology and Neurological Sciences (V.W.H.), Stanford University, CA.
authors.forename: Anne
authors.initials: A
authors.lastname: Ording
authors.affiliation: From the Department of Clinical Epidemiology, Aarhus University Hospital, Denmark (K.A., S.S., J.S., E.H.-P., V.W.H., A.O., L.P., H.T.S.); and Department of Health Research and Policy (Epidemiology) (V.W.H., H.T.S.) and Department of Neurology and Neurological Sciences (V.W.H.), Stanford University, CA.
authors.forename: Lars
authors.initials: L
authors.lastname: Pedersen
authors.affiliation: From the Department of Clinical Epidemiology, Aarhus University Hospital, Denmark (K.A., S.S., J.S., E.H.-P., V.W.H., A.O., L.P., H.T.S.); and Department of Health Research and Policy (Epidemiology) (V.W.H., H.T.S.) and Department of Neurology and Neurological Sciences (V.W.H.), Stanford University, CA.
authors.forename: Henrik Toft
authors.initials: HT
authors.lastname: Sørensen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000453:epidemiology*; D002543:Cerebral Hemorrhage / Q000453:epidemiology*; D015331:Cohort Studies; D003718:Denmark / Q000453:epidemiology; D005260:Female; D006333:Heart Failure / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012042:Registries; D012306:Risk; D020521:Stroke / Q000453:epidemiology*; D013345:Subarachnoid Hemorrhage / Q000453:epidemiology*
keywords: cerebral hemorrhage; heart failure; hemorrhagic; risk factor; stroke, ischemic