Abstract
AimsThe aim of this study was to assess the prognostic value of chronic kidney disease (CKD) in relation to ischaemic stroke, intracranial haemorrhage, major bleeding, and all‐cause death in heart failure patients without atrial fibrillation.Methods and resultsIn this observational cohort study, heart failure patients without atrial fibrillation were identified using Danish nationwide registries. Risk of stroke, major haemorrhage, and death were calculated after 1 and 5 years to compare patients with and without CKD, ±dialysis [dialysis: CKD with renal replacement therapy (CKD‐RRT); no dialysis: CKD‐no RRT]. A total of 43 199 heart failure patients were included, among which 0.8% had CKD‐RRT and 5.9% had CKD‐no RRT. When compared with heart failure patients without CKD, both CKD‐RRT and CKD‐no RRT were associated with a higher 5 year rate of major bleeding (CKD‐RRT: adjusted hazard ratio (aHR): 2.91, 95% confidence interval (CI): 2.29 to 3.70; CKD‐no RRT: aHR: 1.28, 95% CI: 1.13 to 1.45) and all‐cause death (CKD‐RRT: aHR: 2.40, 95% CI: 2.07 to 2.77; CKD‐no RRT: aHR: 1.63, 95% CI: 1.55 to 1.73). For the endpoints of ischaemic stroke and intracranial bleeding, only CKD‐no RRT was associated with significantly higher 5 year rates (ischaemic stroke: aHR: 1.31, 95% CI: 1.13 to 1.52; intracranial haemorrhage: aHR: 1.66, 95% CI: 1.04 to 2.65).ConclusionsCompared with patients without CKD, among incident heart failure patients without atrial fibrillation, CKD both with and without dialysis was associated with a higher rate of major bleeding and all‐cause death. Only CKD‐no RRT was associated with a higher rate of ischaemic stroke and intracranial bleeding.
Highlights
chronic kidney disease (CKD) has been associated with an increased risk of haemorrhagic stroke and major bleeding in patients with cardiovascular disease,[8,9] this has not been described in the Heart failure (HF) population
In this nationwide cohort study of HF patients without diagnosed atrial fibrillation (AF) and not taking anticoagulant therapy, we found higher rates of intracranial haemorrhage, major bleeding, and all-cause death among HF patients with CKD with renal replacement therapy (CKD-RRT) and CKD-no RRT compared with patients without CKD, even after extensive adjustment for concomitant cardiovascular risk factors
For the endpoint ischaemic stroke, only CKD-no RRT was associated with a higher risk
Summary
Heart failure (HF) and chronic kidney disease (CKD) often coexist.[1,2,3] Among HF patients with concomitant CKD, mortality and morbidity are high.[4,5] there are limited data on the risk of stroke and bleeding, especially among HF patients without atrial fibrillation (AF). Chronic kidney disease has been associated with an increased risk of stroke in the general population,[7] but whether CKD is a prognostic factor of stroke in patients with HF has not been investigated. CKD has been associated with an increased risk of haemorrhagic stroke and major bleeding in patients with cardiovascular disease,[8,9] this has not been described in the HF population. As patients with CKD are a heterogeneous group, it may be necessary to subdivide these patients according to disease severity, e.g. CKD requiring dialysis, for optimal assessment of risks and clinical risk stratification
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