Long-term prognosis of combined chronic heart failure and chronic renal dysfunction after acute stroke

Aims To assess the prevalence of combined chronic heart failure and chronic renal dysfunction (CHF–CRD) in acute stroke patients and to investigate any prognostic significance on long-term outcome. Methods and results First-ever acute stroke patients (n = 831) were divided into four groups based on the presence of heart failure (HF, NYHA II–IV with or without left ventricular ejection fraction <40%) and/or renal dysfunction (RD, estimated glomerular filtration rate <60 mL/min/1.73 m2). Patients with acute kidney injury and/or acute decompensated HF were excluded. Group 1 comprised patients without HF or RD (nHF + nRD), Group 2 patients with RD but no HF (nHF + RD), Group 3 those with HF and no RD (HF + nRD), whereas Group 4 included patients with both HF and RD (HF + RD). HF and RD were independent predictors of mortality at 10 years. Patients in Groups 2, 3, and 4 had an increased probability of death during follow-up compared with Group 1: HR 1.34 (95% CI 1.02–1.77, P < 0.05) for group 2; HR 2.24 (95% CI 1.50–3.36, P < 0.001) for group 3; and HR 3.42 (95% CI 2.36–4.95, P < 0.001) for group 4. Age, history of transient ischaemic attacks and combined HF and RD were independent predictors of new cardiovascular events. When compared with Group 1, patients in Group 2 had an HR of 1.48 (95% CI 1.11–1.98, P < 0.01), those in Group 3 an HR of 2.21 (95% CI 1.48–3.29, P < 0.001), and those in Group 4 an HR of 3.59 (95% CI 2.40–5.39, P < 0.001). Conclusion The combination of CHF–CRD after acute stroke is an independent predictor for mortality and new cardiovascular morbidity over 10 years.