Risk of stroke and bleeding in patients with heart failure and chronic kidney disease: a nationwide cohort study

Melgaard, Line; Overvad, Thure Filskov; Skjøth, Flemming; Christensen, Jeppe Hagstrup; Larsen, Torben Bjerregaard; Lip, Gregory Y.H.

doi:10.1002/ehf2.12256

Cited by 10 publications

(5 citation statements)

References 35 publications

(61 reference statements)

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“…The increased risk of bleeding may be due to platelet dysfunction, prolonged bleeding time, and small vessel disease associated with CKD [ 29 ]. Furthermore, the association of CKD with HF episodes confers an extra risk for BE [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

Incidence and prognostic implications of late bleeding events after percutaneous mitral valve repair

Benito‐González

Estévez‐Loureiro

Prado

et al. 2018

IJC Heart & Vasculature

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ObjectivesMitraClip is an established therapy for patients with mitral regurgitation (MR) that are considered of high-risk or inoperable. However, late bleeding events (BE) after hospital discharge and their impact on prognosis in this cohort of patients have been poorly investigated. Our purpose is to address the incidence, related factors and clinical implications of BE after hospital discharge in patients treated with MitraClip.MethodsProspective registry of all consecutive patients (n = 80) who underwent MitraClip implantation in our Institution between June 2014 and December 2017. BE were defined according to MVARC definitions. A combined clinical end-point including admission for heart failure (HF) and all-cause mortality was established to analyze prognostic implications of BE.ResultsDuring a median follow up of 523.5 days, 41 BE were reported in 21 patients. Atrial fibrillation (AF, HR 4.54, CI95% 1.20–17.10) and combined antithrombotic therapy at discharge (HR 3.52, CI95% 1.03–11.34) were independently associated with BE. In the study period, 15 (18.8%) patients died, 20 (25%) were admitted for HF and 29 (36.3%) presented the combined end-point. After multivariable adjustment BE remained independently associated with an adverse outcome (HR 3.80, CI 95% 1.66–8.72). In the subgroup of patients with AF, HAS-BLED score was higher among subjects with BE (3.1 ± 1.3 vs 2.1 ± 0.9, p = 0.003). HAS-BLED score had a significant discrimination power for the occurrence BE (AUC: 0.677 [0.507–0.848]) in this subgroup.ConclusionsBE are common after MitraClip and are associated with an impaired outcome. Strategies to reduce bleeding events are paramount in this cohort of patients.

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Section: Discussionmentioning

confidence: 99%

Incidence and prognostic implications of late bleeding events after percutaneous mitral valve repair

Benito‐González

Estévez‐Loureiro

Prado

et al. 2018

IJC Heart & Vasculature

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“…85 In the Danish nationwide registry, among patients with HF, those with chronic renal disease had a 30% higher stroke risk compared to patients without. 86 Beside these risk factors, any (systemic) clinical characteristics that may increase the likelihood of thrombus formation may further add to the HF-related risk of stroke, including chronic inflammatory diseases and venous vascular comorbidities.…”

Section: Stratification Of Stroke Risk In Heart Failure Patientsmentioning

confidence: 99%

“…Renal function is related to higher stroke risk in patients with HF 85 . In the Danish nationwide registry, among patients with HF, those with chronic renal disease had a 30% higher stroke risk compared to patients without 86 …”

Section: Stratification Of Stroke Risk In Heart Failure Patientsmentioning

confidence: 99%

Interaction of heart failure and stroke: A clinical consensus statement of the ESC Council on Stroke, the Heart Failure Association (HFA) and the ESC Working Group on Thrombosis

Doehner,

Böhm,

Boriani

et al. 2023

European J of Heart Fail

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Heart failure (HF) is a major disease in our society that often presents with multiple comorbidities with mutual interaction and aggravation. The comorbidity of HF and stroke is a high risk condition that requires particular attention to ensure early detection of complications, efficient diagnostic workup, close monitoring, and consequent treatment of the patient. The bi‐directional interaction between the heart and the brain is inherent in the pathophysiology of HF where HF may be causal for acute cerebral injury, and ‐ in turn ‐ acute cerebral injury via imbalanced neural and neurovegetative control of cardiovascular regulation may induce or aggravate HF.The present document represents the consensus view of the ESC Council on Stroke, the Heart Failure Association and the ESC Working Group on Thrombosis to summarize current insights on pathophysiologic interactions of the heart and the brain in the comorbidity of HF and stroke. Principal aspects of diagnostic workup, pathophysiologic mechanisms, complications clinical management in acute conditions and in long‐term care of patients with the comorbidity are presented and state of the art clinical management and current evidence from clinical trials is discussed. Beside the physicians perspective, also the patients values and preferences are taken into account.Interdisciplinary cooperation of cardiologists, stroke specialists, other specialists and primary care physicians is pivotal to ensure optimal treatment in acute events and in continued long‐term treatment of these patients. Key consensus statements are presented in a concise overview on mechanistic insights, diagnostic workup, prevention and treatment to inform clinical acute and continued care of patients with the comorbidity of heart failure and stroke.

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“…Several studies investigated the impact of renal function on stroke risk in HF. Melgaard et al showed an increased risk of ischemic stroke and intracranial bleeding in HF patients with stable chronic kidney disease, but this association could only be found in patients without renal replacement therapy [ 70 ]. These findings are in agreement with the results of another study showing an association between estimated glomerular filtration rate and stroke risk in HF patients [ 64 ].…”

Section: Risk Stratification Of Stroke In Hfmentioning

confidence: 99%

Heart Failure and Stroke

Schumacher

Kornej

Shantsila

et al. 2018

Curr Heart Fail Rep

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PurposeIschemic stroke significantly contributes to morbidity and mortality in heart failure (HF). The risk of stroke increases significantly, with coexisting atrial fibrillation (AF). An aggravating factor could be asymptomatic paroxysms of AF (so-called silent AF), and therefore, the risk stratification in these patients remains difficult. This review provides an overview of stroke risk in HF, its risk stratification, and stroke prevention in these patients.Recent FindingsStroke risk stratification in HF patients remains an important issue. Recently, the CHA2DS2-VASc score, originally developed to predict stroke risk in AF patients, had been reported to be a predictive for strokes in HF patients regardless of AF being present. Furthermore, there are several independent risk factors (e.g., hypertension, diabetes mellitus, prior stroke) described.SummaryBased on the current evidence, HF should be considered as an independent risk factor for stroke. The CHA2DS2-VASc score might be useful to predict stroke risk in HF patients with or without AF in clinical routine. However, there is only a recommendation for the oral anticoagulation use in patients with concomitant HF and AF, while in patients with HF and no AF, individualized risk stratification is preferred. Current guidelines recommend to prefer non-vitamin Kantagonist anticoagulants over warfarin.

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Risk of stroke and bleeding in patients with heart failure and chronic kidney disease: a nationwide cohort study

Cited by 10 publications

References 35 publications

Incidence and prognostic implications of late bleeding events after percutaneous mitral valve repair

Incidence and prognostic implications of late bleeding events after percutaneous mitral valve repair

Interaction of heart failure and stroke: A clinical consensus statement of the ESC Council on Stroke, the Heart Failure Association (HFA) and the ESC Working Group on Thrombosis

Heart Failure and Stroke

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