Revascularisation Therapies Improve the Outcomes of Ischemic Stroke Patients with Atrial Fibrillation and Heart Failure

Tiberiu Pana, Mohamed O. Mohamed, Allan B Clark, Eoin Fahy , Mamas A Mamas, Phyo K Myint* (Corresponding Author)

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

4 Citations (Scopus)
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BackgroundAtrial fibrillation (AF) and heart failure (HF) carry a poor prognosis in acute ischaemic stroke (AIS). The impact of revascularisation therapies on outcomes in these patients is not fully understood.MethodNational Inpatient Sample (NIS) AIS admissions (January 2004–September 2015) were included ( n = 4,597,428). Logistic regressions analysed the relationship between exposures (neither AF nor HF-reference, AF-only, HF-only, AF + HF) and outcomes (in-hospital mortality, length-of-stay >median and moderate-to-severe disability on discharge), stratifying by receipt of intravenous thrombolysis (IVT) or endovascular thrombectomy (ET).Results69.2% patients had neither AF nor HF, 16.5% had AF-only, 7.5% had HF-only and 6.7% had AF + HF. 5.04% and 0.72% patients underwent IVT and/or ET, respectively. AF-only and HF-only were each associated with 75–85% increase in the odds of in-hospital mortality. AF + HF was associated with greater than two-fold increase in mortality. Patients with AF-only, HF-only or AF + HF undergoing IVT had better or at least similar in-hospital outcomes compared to their counterparts not undergoing IVT, except for prolonged hospitalisation. Patients undergoing ET with AF-only, HF-only or AF + HF had better (in-hospital mortality, discharge disability, all-cause bleeding) or at least similar (length-of-stay) outcomes to their counterparts not undergoing ET. Compared to AIS patients without AF, AF patients had approximately 50% and more than two-fold increases in the likelihood of receiving IVT or ET, respectively.ConclusionsWe confirmed the combined and individual impact of co-existing AF or HF on important patient-related outcomes. Revascularisation therapies improve these outcomes significantly in patients with these comorbidities.
Original languageEnglish
Pages (from-to) 205-213
Number of pages9
JournalInternational Journal of Cardiology
Early online date3 Oct 2020
Publication statusPublished - 1 Feb 2021

Bibliographical note

Funding Information:
We would like to acknowledge the HCUP Data Partners ( TA Pana, Prof Myint and Prof Mamas conceived the study. Data were analysed by TA Pana under the supervision of Dr. Mohamed and Prof Myint. TA Pana and Prof Myint drafted the article, and all the authors contributed in writing the article. Prof Myint is the guarantor.
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.


  • Atrial fibrillation
  • Heart failure
  • Cerebrovascular disease
  • Stroke
  • Thrombolysis
  • Thrombectomy


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