Abstract
Background: Heart failure (HF), traditionally considered a disease of the elderly, is the second leading cause of cardioembolic stroke. In young adults however the prevalence and outcomes following HF-related stroke remain unclear. Here we investigate the prevalence of HF among young adults with ischemic stroke and analyze in-hospital outcomes. Methods: Using the National Inpatient Sample (2012-2018) we performed a retrospective analysis of all ischemic stroke hospitalizations among young adults (18-45) using previously validated ICD-9 and 10 codes. Presence of HF and relevant covariates were also extracted. Poor functional outcome was defined as either discharge to nursing facility, placement of percutaneous endoscopic gastrostomy tube or tracheostomy. Multivariable logistic and linear regression models were used to compare outcomes. Results: 65,160 young adults were hospitalized for ischemic stroke, 12% with comorbid heart failure. A greater proportion of patients with HF were men (61% vs 50% p < 0.001), of Black race (35% vs 24%, p < 0.001) and of the lowest income quartile (40% vs 34% p < 0.001). Along with traditional vascular risk factors (atrial fibrillation, hypertension, diabetes, and coronary artery disease, all p < 0.05), renal failure and COPD were also more prevalent in young adults with HF (24% vs 7% and 5% vs 2%, both p <0.001). HF was associated with longer hospitalizations (15.0 [0.23] vs 8.5 [0.06] days, p<0.001) and greater total charges ($240,665 vs $125,201, p<0.001). In crude analysis, HF was associated with significantly increased odds of poor functional outcome (OR 1.72, 95% CI: 1.64-1.81) and death (OR 2.86, 95% CI: 2.69-3.05). After adjustment for demographics, hospital factors, comorbidities, and disease severity, mortality remained significant (1.38, 95% CI: 1.27-1.51). Conclusion: Disparities in prevalent HF exist among young adults with ischemic stroke. HF is associated with longer and more expensive stroke hospitalizations in young adults and significantly greater odds of death. Along with traditional vascular risk factors, pulmonary and renal disease are more prevalent in young stroke patients with HF. Further research may identify prevention strategies to improve outcomes in these young, high-risk patients.
Published Version
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