Risk of stroke in patients with heart failure and sinus rhythm: data from the Swedish Heart Failure Registry

AIMS: We investigated the 2 year rate of ischaemic stroke/transient ischaemic attack (IS) in patients with heart failure (HF) who were in sinus rhythm (HF‐SR) and aimed to develop a score for stratifying risk of IS in this population. METHODS AND RESULTS: A total of 15 425 patients (mean age 71.5 years, 39% women) with HF‐SR enrolled in the Swedish Heart Failure Register were included; 28 815 age‐matched and sex‐matched controls, without a registered diagnosis of HF, were selected from the Swedish Population Register. The 2 year rate of IS was 3.0% in patients and 1.4% in controls. In the patient group, a risk score including age (1p for 65–74 years; 2p for 75–84 years; 3p for ≥85 years), previous IS (2p), ischaemic heart disease, diabetes, hypertension, kidney dysfunction, and New York Heart Association III/IV class (1p each) was generated. Over a mean follow‐up of 20.1 (SD 7.5) months, the cumulative incidences (per 1000 person‐years) of IS in patients with score 0 to ≥7 were 2.2, 5.3, 8.9, 13.2, 15.7, 20.4, 26.4, and 33.0, with hazard ratios for score 1 to ≥7 (with 0 as reference): 2.4, 4.1, 6.1, 7.2, 9.4, 12.2, and 15.3. The risk score performed modestly (area under the curve 63.7%; P = 0.4711 for lack of fit with a logistic model; P = 0.7062 with Poisson, scaled by deviance). CONCLUSIONS: In terms of absolute risk, only 27.6% of patients had an annual IS incidence of ≤1%. To which extent this would be amenable to anticoagulant treatment remains conjectural. A score compiling age and specific co‐morbidities identified HF‐SR patients with increased risk of IS with modest discriminative ability.