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Rheumatic mitral valve disease is associated with worse outcomes in stroke: a Thailand National Database Study

Mamas

Authors



Abstract

Background and Purpose—
Rheumatic valvular heart disease is associated with the increased risk of cerebrovascular events, although there are limited data on the prognosis of patients with rheumatic mitral valve disease (RMVD) after stroke.

Methods—
We examined the association between RMVD and both serious and common cardiovascular and noncardiovascular (respiratory and infective) complications in a cohort of hospitalized stroke patients based in Thailand. Factors associated with in-hospital mortality were also explored. Data were obtained from a National Insurance Database. All hospitalized strokes between October 1, 2004, and January 31, 2013, were included in the current study. Characteristics and outcomes were compared for RMVD and non-RMVD patients. Logistic regression, propensity score matching, and multivariate models were used to assess study outcomes.

Results—
In total, 594?681 patients (mean [SD] age=64 [14.5] years) with a diagnosis of stroke (ischemic=306?154; hemorrhagic=195?392; undetermined=93?135) were included in this study, of whom 5461 had RMVD. Results from primary analyses showed that after ischemic stroke, and controlling for potential confounding covariates, RMVD was associated (P<0.001) with increased odds for cardiac arrest (odds ratio [95% confidence interval]=2.13 [1.68–2.70]), shock (2.13 [1.64–2.77]), arrhythmias (1.70 [1.21–2.39]), respiratory failure (2.09 [1.87–2.33]), pneumonia (2.00 [1.81–2.20]), and sepsis (1.39 [1.19–1.63]). In hemorrhagic stroke patients, RMVD was associated with increased odds (fully adjusted model) for respiratory failure (1.26 [1.01–1.57]), and in patients with undetermined stroke, RMVD was associated with increased odds (fully adjusted analyses) for shock (3.00 [1.46–6.14]), respiratory failure (2.70 [1.91–3.79]), and pneumonia (2.42 [1.88–3.11]).

Conclusions—
RMVD is associated with the development of cardiac arrest, shock, arrhythmias, respiratory failure, pneumonia, and sepsis after acute stroke.

Acceptance Date Aug 29, 2016
Publication Date Oct 4, 2016
Publicly Available Date Mar 29, 2024
Journal Stroke
Print ISSN 0039-2499
Publisher American Heart Association
Pages 2695-2701
DOI https://doi.org/10.1161/STROKEAHA.116.014512
Keywords complications, epidemiology, mortality, rheumatic heart disease, stroke
Publisher URL http://dx.doi.org/10.1161/STROKEAHA.116.014512