# Heart failure, recurrent vascular events and death in patients with ischemic stroke—results of the MonDAFIS study

## TL;DR

This study finds that heart failure increases the risk of heart attacks and death in patients with ischemic stroke, but not the risk of recurring strokes or bleeding.

## Contribution

The study provides new evidence on the specific risks associated with heart failure in ischemic stroke patients from a large, multicenter trial.

## Key findings

- Heart failure increases the risk of myocardial infarction and all-cause death in stroke patients.
- The risk of recurrent stroke or major bleeding is not significantly higher in heart failure patients.
- Adjustments for age, stroke severity, and cardiovascular risk factors were made in the analysis.

## Abstract

Heart failure (HF) is associated with poor outcome after stroke, but data from large prospective trials are sparse.

We assessed the impact of HF on clinical endpoints in patients hospitalized with acute ischemic stroke or transient ischemic attack (TIA) enrolled in the prospective, multicenter Systematic Monitoring for Detection of Atrial Fibrillation in Patients with Acute Ischemic Stroke (MonDAFIS) trial. HF was defined as left ventricular ejection fraction (LVEF) < 55% or a history of HF on admission. The composite of recurrent stroke, major bleeding, myocardial infarction, and all-cause death, and its components during the subsequent 24 months were assessed. We used estimated hazard ratios in confounder-adjusted models. Overall, 410/2562 (16.0%) stroke patients fulfilled the HF criteria (i.e. 381 [14.9%] with LVEF < 55% and 29 [1.9%] based on medical history). Patients with HF had more often diabetes, coronary and peripheral arterial disease and presented with more severe strokes on admission. HF at baseline correlated with myocardial infarction (HR 2.21; 95% CI 1.02–4.79), and all-cause death (HR 1.67; 95% CI 1.12–2.50), but not with major bleed (HR 1.93; 95% CI 0.73–5.06) or recurrent stroke/TIA (HR 1.08; 95% CI 0.75–1.57). The data were adjusted for age, stroke severity, cardiovascular risk factors, and randomization. Patients with ischemic stroke or TIA and comorbid HF have a higher risk of myocardial infarction and death compared with non-HF patients whereas the risk of recurrent stroke or major hemorrhage was similar. Trial registration number Clinicaltrials.gov NCT02204267.

The online version contains supplementary material available at 10.1007/s11739-024-03594-8.