Clinical Epidemiology (Feb 2023)
Large Burden of Stroke Incidence in People with Cardiac Disease: A Linked Data Cohort Study
Abstract
Keira Robinson,1 Judith M Katzenellenbogen,1 Timothy J Kleinig,2 Joosup Kim,3,4 Charley A Budgeon,1 Amanda G Thrift,4 Lee Nedkoff1,5 1School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia; 2Department of Neurology, Royal Adelaide Hospital, Adelaide, South Australia, Australia; 3Department of Medicine, The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Victoria, Australia; 4Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia; 5Victor Chang Cardiac Research Institute, Sydney, New South Wales, AustraliaCorrespondence: Keira Robinson, School of Population and Global Health, The University of Western Australia, M431, 35 Stirling Hwy, Crawley, WA, 6009, Australia, Email [email protected]: People with cardiac disease have 2– 4 times greater risk of stroke than the general population. We measured stroke incidence in people with coronary heart disease (CHD), atrial fibrillation (AF) or valvular heart disease (VHD).Methods: We used a person-linked hospitalization/mortality dataset to identify all people hospitalized with CHD, AF or VHD (1985– 2017), and stratified them as pre-existing (hospitalized 1985– 2012 and alive at October 31, 2012) or new (first-ever cardiac hospitalization in the five-year study period, 2012– 2017). We identified first-ever strokes occurring from 2012 to 2017 in patients aged 20– 94 years and calculated age-specific and age-standardized rates (ASR) for each cardiac cohort.Results: Of the 175,560 people in the cohort, most had CHD (69.9%); 16.3% had multiple cardiac conditions. From 2012– 17, 5871 first-ever strokes occurred. ASRs were greater in females than males in single and multiple condition cardiac groups, largely driven by rates in females aged ≥ 75 years, with stroke incidence in this age group being at least 20% greater in females than males in each cardiac subgroup. In females aged 20– 54 years, stroke incidence was 4.9-fold greater in those with multiple versus single cardiac conditions. This differential declined with increasing age. Non-fatal stroke incidence was greater than fatal stroke in all age groups except in the 85– 94 age group. Incidence rate ratios were up to 2-fold larger in new versus pre-existing cardiac disease.Conclusion: Stroke incidence in people with cardiac disease is substantial, with older females, and younger patients with multiple cardiac conditions, at elevated risk. These patients should be specifically targeted for evidence-based management to minimize the burden of stroke.Keywords: stroke incidence, coronary heart disease, valvular heart disease, atrial fibrillation, cardiac disease, risk factors
