Diabetes and long-term outcomes of ischaemic stroke: Findings from get with the guidelines-stroke

Justin B. Echouffo-Tcheugui, Haolin Xu, Roland A. Matsouaka, Ying Xian, Lee H. Schwamm, Eric E. Smith, Deepak L. Bhatt, Adrian F. Hernandez, Paul A. Heidenreich, Gregg C. Fonarow

Research output: Contribution to journalArticle

Abstract

Aims There is a paucity of data on the influence of diabetes on long-term outcomes after ischaemic stroke (IS). We assessed whether outcomes after IS differ between patients with and without diabetes. Methods Patients aged >_65 years (n = 409 060) in Get With The Guidelines-Stroke (nationwide registry of stroke patients and results from 1690 sites in the USA) were followed for 3 years post-discharge. The outcomes of interest were mortality, cardiovascular and non-cardiovascular hospitalizations, heart failure (HF), and recurrence of IS/transient ischaemic attack (TIA). Patients with diabetes (29.6%) were younger and had more comorbidities. At 3 years post-discharge after IS, diabetes was associated with higher risks of adverse outcomes: all-cause mortality [cumulative incidence 46.0% vs. 44.2%, absolute difference (AD) 1.8%; adjusted hazard ratio (aHR) 1.24, 95% confidence interval 1.23–1.25], all-cause readmission (71.3% vs. 63.7%, AD 7.6%; aHR 1.22, 1.21–1.23), composite of mortality and all-cause readmission (84.1% vs. 79.3%, AD 4.8%; aHR 1.21, 1.20–1.22), composite of mortality and cardiovascular readmission (69.5% vs. 64.3%, AD 5.2%; aHR 1.19, 1.18–1.20), IS/TIA readmission (15.9% vs. 13.3%, AD 2.6%; aHR 1.18, 1.16–1.20), HF readmission (10.3% vs. 6.4%, AD 3.9%; aHR 1.60, 1.56–1.64), non-cardiovascular readmission (58.3% vs. 50.3%, AD 8.0%; aHR 1.28, 1.26–1.29), and non-IS/TIA readmission (67.6% vs. 59.7%, AD 7.9%; aHR 1.23, 1.22–1.25). Accounting for the initial severity of stroke using the National Institute of Health Stroke Scale as well as using propensity score matching method as a sensitivity analysis, did not modify the results.Conclusion Among older IS patients diabetes was associated with increased risks of death, cardiovascular and non-cardiovascular hospitalizations, HF, and IS/TIA recurrence.

Original languageEnglish (US)
Pages (from-to)2376-2386
Number of pages11
JournalEuropean heart journal
Volume39
Issue number25
DOIs
StatePublished - Jul 1 2018
Externally publishedYes

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Keywords

  • Diabetes
  • Glycated haemoglobin
  • Ischaemic stroke
  • Stroke
  • Transient ischaemic attack

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Echouffo-Tcheugui, J. B., Xu, H., Matsouaka, R. A., Xian, Y., Schwamm, L. H., Smith, E. E., Bhatt, D. L., Hernandez, A. F., Heidenreich, P. A., & Fonarow, G. C. (2018). Diabetes and long-term outcomes of ischaemic stroke: Findings from get with the guidelines-stroke. European heart journal, 39(25), 2376-2386. https://doi.org/10.1093/eurheartj/ehy036