Cardiovascular disease and outcome of acute stroke: influence of pre-existing cardiac failure

Background and aims: Whilst a number of variables, mostly a consequence of a stroke, are known to predict mortality of acute stroke there is limited i nformation on the significance of pre-existing cardiovascular variables on stroke mortality. We have investigated the influence of pre-existing cardio vascular factors in one cohort of stroke patients. Methods: We studied 295 patients, mean age 74 +/- 10 (range 34-96) years; 133 males, presenting wit h acute stroke for pre-existing cardiovascular disease (CVD) defined as hyp ertension, atrial fibrillation (AF), ischaemic heart disease (IHD) and card iac failure (CF). In addition, data were collected on epidemiological and n eurological variables known to influence stroke mortality. The most signifi cant of the cardiovascular factors was further investigated against all the other cardiovascular groups together and against those without any CVD. Ou tcome was measured as their influence on acute phase and 3-month mortality. Results: There was no significant difference in 3-month mortality with hyp ertension (P = 0.62) arid IHD (P = 0.33) but there was a significant higher mortality in patients with AF (P = 0.05) and CF (P < 0.001). CF was mole s ignificant than all other CVD (hypertension + AF + IHD) together without th e failure (P < 0.001); odds ratio of 4.5 (95% CI 2.28-9.07). Partial correl ation coefficient revealed CF to be an independent significant variable to influence stroke mortality when controlled with AF, stroke syndromes, age, incontinence, pyrexia, dysphagia and Glasgow coma score. Conclusions: Pre-e xisting CF has an adverse influence on stroke mortality independent of othe r known factors. Cardiovascular factors without failure do not have such an effect except the marginal effect of AF. (C) 2000 European Society of Card iology. All rights reserved.