https://orcid.org/0000-0002-9611-6598
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Abstract
Purpose
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.
Data Sharing Statement
Data for this study are provided by the WA Department of Health and are not able to be shared with external parties due to governance restrictions.
Ethics Approval
The study was conducted after approval by the WA Department of Health Human Research Ethics Committee (2014/55). Use of the data was approved under a waiver of informed consent. The data accessed was de-identified (anonymized) and complied with the data protection and privacy regulations relevant to WA. No other approvals were required for data access.
Acknowledgments
We thank the following for data: WA Data Linkage Branch and WA Department of Health data custodians for Hospital Morbidity Data Collection and Death Registrations data; the Australian Co-ordinating Registry, the Registries of Births, Deaths and Marriages, the Coroners, the National Coronial Information System and the Victorian Department of Justice and Community Safety, for enabling use of cause of death data.
Author Contributions
All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.
Disclosure
LN and JK are funded by National Heart Foundation of Australia Future Leader Fellowships. The authors report no other conflicts of interest in this work.