In-Hospital Outcomes of Acute Ischemic Stroke in Patients With Hypertrophic Cardiomyopathy

Daokun Sun; Hartzell V Schaff; Rick A Nishimura; Jeffrey B Geske; Joseph A Dearani; Steve R Ommen

doi:10.1016/j.mayocpiqo.2022.12.003

In-Hospital Outcomes of Acute Ischemic Stroke in Patients With Hypertrophic Cardiomyopathy

Mayo Clin Proc Innov Qual Outcomes. 2022 Dec 30;7(1):45-50. doi: 10.1016/j.mayocpiqo.2022.12.003. eCollection 2023 Feb.

Authors

Daokun Sun¹, Hartzell V Schaff¹, Rick A Nishimura², Jeffrey B Geske², Joseph A Dearani¹, Steve R Ommen²

Affiliations

¹ Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN.
² Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.

Abstract

Objective: To investigate the in-hospital outcomes of acute ischemic stroke in patients with hypertrophic cardiomyopathy (HCM).

Patients and methods: Using weighted discharge data from the National Inpatient Sample, we identified 5804 nonelective hospitalizations for ischemic stroke in adult patients with HCM between 2011 and 2017. For comparison, 58,179 hospitalizations for ischemic stroke in adult patients without HCM were selected as controls using the simple random sampling method.

Results: Compared with the patients without HCM, those with HCM had a higher prevalence of hyperlipidemia (62.4% vs 57.5%, respectively, P<.001) and chronic heart failure (25.4% vs 13.6%, respectively, P<.001) but a lower prevalence of diabetes (28.2% vs 34.9%, respectively, P<.001) and hypertension (42.9% vs 53.4%, respectively, P<.001). Atrial fibrillation was documented in 45.1% (n=2617) of the patients with HCM. However, only 28.0% (n=733) of these patients had long-term use of anticoagulants. The in-hospital death rate among the patients with HCM was 6.3% (n=368), which was significantly higher than that in the patients without HCM (4.1%, P<.001). Having HCM (odds ratio [OR], 1.35; P<.001), atrial fibrillation (OR, 2.08; P<.001), and chronic heart failure (OR, 1.65; P<.001) were significant predictors of in-hospital death. In patients with HCM who were discharged alive, 50.0% were transferred to skilled nursing facilities compared with 45.3% of those without HCM (P<.001).

Conclusion: The prognosis of acute ischemic stroke is worse in patients with HCM than in those without HCM. These findings emphasize the importance of aggressive treatment of predisposing factors for stroke in patients with HCM, especially atrial fibrillation.

Keywords: AF, atrial fibrillation; HCM, hypertrophic cardiomyopathy; ICD-10, International Statistical Classification of Diseases and Related Health Problems, Tenth Revision; NIS, National Inpatient Sample.