Age Stratification in Acute Ischemic Stroke Patients with Heart Failure.

Background and Purpose . Heart failure (HF) is considered one of the major risk factors associated with the severity of acute ischemic stroke(AIS). The risk factors associated with stroke severity in AIS with a history of HF is not fully understood. Methods . A prospectively maintained database from comprehensive stroke centers in PRISMA Health Upstate Sc, was analyzed for patients with AIS and a history of HF from January 2010 to 30 June 2016. The primary outcome was risk factors associated with a National Institute of Health Stroke Scale score (NIHSS) < 7 indicating lower severity and a score ≥ 7 indicating high severity for 65-74 age category and ≥75 years age category for AIS-HF patients. Univariate analysis was used to determine risk factors based on age categories and stroke severities, while multivariable analysis was used to adjust for the effect of confounding variables. Results : A total 367 AIS-HF patients were identified in this study, 113 patients were between 65-74 years old, while 254 patients were in the ≥75 years old age category. In the adjusted analysis for 65-74 age category, history of smoking (OR = 0.105, 95% Confidence interval (CI): 0.018-0.614, p = 0.012), triglycerides (Odd ratio(OR) = 0.993, 95% (CI): 0.987-0.999, p = 0.019), and International Normalized Ratio (INR) (OR = 0.454, 95% CI: 0.196-1.050, p = 0.045), and direct admission treatment (OR = 0.355, 95% CI: 0.137-0.920, p = 0.033) were associated with a lower stroke severity, elevated heart rate (OR = 1.032, 95% CI: 1.009-1.057, p = 0.007) was associated with a higher stroke severity. For the ≥75 years old age category, previous stroke (OR = 2.297, 95% CI: 1.171-9.852, p = 0.024), peripheral vascular disease (OR = 6.784, 95% CI: 1.242-37.065, p = 0.027), heart rate (OR = 1.035, 95% CI: 1.008-1.063, p = 0.012), and systolic blood pressure (OR = 1.023, 95% CI: 1.005-1.041, p = 0.012) were associated with a higher severe stroke severity. Conclusions : After adjusting for the effect of potential confounders, more risk factors were associated with a high severity of stroke among ≥75 years old compared with 65-74 years old AIS-HF patients. Elevated heart rate was an independent risk factor associated with stroke severity in 65-74 and ≥75 years old AIS-HF patients. Elevated heart rate and other identified risk factors should be managed to reduce stroke severity among elderly AIS-HF patients.