Abstract
BACKGROUND: Although many studies have examined the influence of individual preexisting heart conditions on stroke outcomes, the combined effects of these conditions remain understudied. METHODS: The data supporting this study's findings are available from the corresponding author upon reasonable request. Data on patients with acute ischemic stroke from the Third China National Stroke Registry were analyzed. Preexisting heart disease spectrum was defined based on the combination pattern of coronary heart disease, atrial fibrillation, and heart failure. In-hospital stroke outcomes included moderate or severe stroke at admission (the National Institutes of Health Stroke Scale score ≥16), ambulation by day 2, and in-hospital death. RESULTS: Among the 14 019 analyzed patients, 1856 (13.2%) had preexisting heart diseases, of which the most common single heart disease was coronary heart disease (1313 [70.7%]), and the most common combination was coronary heart disease and atrial fibrillation (116 [6.3%]). Patients with preexisting heart diseases had higherprevalence of moderate or severe stroke at admission (4.7% versus 1.9%; adjusted odds ratio [aOR], 2.25 [95% CI, 1.73-2.93]), in-hospital mortality (0.5% versus 0.2%; aOR, 2.41 [95% CI, 1.11-5.25]), and a lower rate of ambulation by day 2 (73.9% versus 78.6%; aOR, 0.84 [95% CI, 0.75-0.95]). Atrial fibrillation alone (moderate or severe stroke: aOR, 4.82 [95% CI, 3.29-7.06]; in-hospital mortality: aOR, 4.76 [95% CI, 1.58-14.36]; ambulation by day 2: aOR, 0.58 [95% CI, 0.46-0.72]) or in combination with coronary heart disease and heart failure (moderate or severe stroke: aOR, 11.47 [95% CI, 3.66-35.89]; ambulation by day 2: aOR, 0.41 [95% CI, 0.16-1.05]) had the strongest association with unfavorable outcomes. CONCLUSION: Preexisting heart diseases, particularly atrial fibrillation combined with other heart diseases, are associated with unfavorable in-hospital stroke outcomes.