Abstract
Cardiovascular and cerebrovascular diseases are frequently interconnected due to underlying pathology involving atherosclerosis and thromboembolism. The aim of this study was to investigate the impact of clinical interactions among cardiovascular and cerebrovascular diseases on patient outcomes using a large-scale nationwide claims-based dataset. Cardiovascular diseases were defined as myocardial infarction, heart failure, atrial fibrillation, and aortic dissection. Cerebrovascular diseases were defined as cerebral infarction, intracerebral hemorrhage, and subarachnoid hemorrhage. This retrospective study included 2,736,986 inpatient records (1,800,255 patients) at 911 hospitals from 2015 to 2016 from Japanese registry of all cardiac and vascular disease-diagnostic procedure combination dataset. Interactions among comorbidities and complications, rehospitalization, and clinical outcomes including in-hospital mortality were investigated. Among hospitalization records that involved cardiovascular disease, 5.9% (32,686 records) had cerebrovascular disease as a comorbidity and 2.1% (11,362 records) included an incident cerebrovascular complication after hospitalization. Cerebrovascular disease as a comorbidity or complication was associated with higher in-hospital mortality than no cerebrovascular disease (adjusted odds ratio (OR) [95% confidence interval]: 1.10 [1.06–1.14], 2.02 [1.91–2.13], respectively). Among 367,904 hospitalization records that involved cerebrovascular disease, 17.7% (63,647 records) had cardiovascular disease listed as comorbidity and 3.3% (11,834 records) as a complication. Only cardiovascular disease as a complication was associated with higher in-hospital mortality (adjusted OR [95% confidence interval]: 1.29 [1.22–1.37]). In addition, in-hospital mortality during rehospitalization due to the other disease was significantly higher than mortality during the hospitalization due to the first disease. In conclusion, substantial associations were observed between cardiovascular and cerebrovascular disease in a large-scale nationwide claims-based dataset; these associations had a significant impact on clinical outcomes. More intensive prevention and management of cardiovascular and cerebrovascular disease might be crucial.
Highlights
According to the World Health Organization, cardiovascular and cerebrovascular diseases are the most frequent causes of death worldwide, accounting for 31% of all deaths in 2016 globally [1]
Cardiovascular risk factors are associated with the development of arrhythmias such as atrial fibrillation (AF), which predisposes a person to cerebrovascular events when blood clots in the atria and ventricles embolize to the brain
Cardiovascular and cerebrovascular diseases as comorbidities and complications Among 2,736,986 records of 1,800,255 patients at 911 hospitals, 541,481 records were extracted as hospitalization due to cardiovascular disease and 364,625 records were extracted as hospitalization due to cerebrovascular disease (Fig 1)
Summary
According to the World Health Organization, cardiovascular and cerebrovascular diseases are the most frequent causes of death worldwide, accounting for 31% of all deaths in 2016 globally [1]. Both are frequently interconnected with common risk factors and underlying pathology such as atherosclerosis, a condition that damages medium and large arteries. Ischemic stroke is a feared complication of acute myocardial infarction (MI), which is a strong predictor of mortality [4]. Several cardiac disorders such as AF, valvular disease, and acute MI, are associated with an increased risk of ischemic stroke. Cardiovascular-cerebrovascular disorders require a multidisciplinary diagnostic and therapeutic approach [5]
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