Risk Predictors of 3-Month and 1-Year Outcomes in Heart Failure Patients with Prior Ischemic Stroke

Abstract

Background: Despite available therapy, mortality, and readmission rates within 60–90 days of discharge for patients hospitalized with heart failure (HF) are higher compared to the 1-year rates. This study sought to identify the risk factors of the combined endpoint of all-cause readmission or death among HF patients. Methods: Patients with a diagnosis of HF aged 65 or older were included in this prospective observational cohort study. The outcomes were estimated within 3-months and 1 year of discharge. Risk modeling was performed using a multivariable Cox regression analysis of HF patients older than 65 who had experienced ischemic stroke. Results: A total of 951 HF patients enrolled, of whom 340 (35.8%) had suffered a prior ischemic stroke. Significant predictors of increased 3-month all-cause readmission or death included DBP (p = 0.045); serum albumin (p = 0.025), TSH (p = 0.017); and discharge without ACE-inhibitor/ARB/ARNI (p = 0.025), β-blockers (p = 0.029), and antiplatelet drugs (p = 0.005). Heart rate (p = 0.040), laboratory parameters—including serum albumin (p = 0.003), CRP p = 0.028), and FT4 (p = 0.018)—and discharge without β-blockers (p = 0.003), were significant predictors of increased 1-year all-cause readmission and death. Conclusions: Without β-blockers, lower serum albumin and abnormal thyroid function increase the risks of readmission and death in elderly HF patients who have had an ischemic stroke by 3 months and 1 year after discharge. The other factors, such as being without ACEI/ARB and a high heart rate, only increase risks before 3 months or 1 year, not both.