Abstract WMP41: Heart Failure, Age And Functional Outcomes After Ischemic Stroke

Background: The presence of cardiovascular risk factors and associated diseases, including heart failure (HF), has been associated with worse outcomes following stroke. It is unclear however whether the association between HF and poor outcomes persists in younger cohorts, in whom HF is less often a consequence of long-standing cardiovascular disease. We hypothesize prevalent heart failure has differential associations with post-stroke functional outcomes across age groups. Methods: We performed a retrospective analysis of patients admitted with acute ischemic stroke at Columbia University Medical Center between 1990-2020 for whom adjudicated data was available at the time of analyses. Demographic, clinical variables including NIHSS and TPA administration, and functional outcomes were extracted. Good functional outcome was defined as a discharge modified Rankin score ≤ 2. Multivariable regression models were used to determine adjusted odds ratios (aORs) and 95% confidence intervals (95% CI). Results: Of the 855 patients hospitalized with ischemic stroke, 47% were women, 32% were ≤ 60 years, and 139 (16%) had pre-existing heart failure. Good functional outcome was seen in 456 (53%), in patients who had a mean age of 67.2 (16.4) years. Age as a continuous measure modified the effect of prevalent heart failure on the odds of good functional outcome (P = 0.001 for interaction). Among patients ≤ 60 years, after controlling for cardiovascular risk factors, NIHSS and TPA use, prevalent heart failure was associated with greater odds of good functional outcome (aOR: 1.33, 95% CI: 1.08-13.14) compared to young adults without HF. Among older stroke patients, HF was non-significantly associated with lower odds of good functional outcome (aOR: 0.86, 95% CI: 0.50-1.50). Conclusion: Premature heart failure (often due to congenital defects, hereditary cardiomyopathies, infections or other non-vascular etiologies) in younger stroke patients may be a marker of lower cardiovascular disease burden compared to young adults with stroke secondary to traditional stroke risk factors. These factors may play a larger role in post-stroke outcomes and recovery.