Heart failure & cardiomyopathiesMeta-analysis
Stroke in Heart Failure With Reduced Ejection Fraction
- Systematic review and meta-analysis of randomised trials
- meta-regression
Authors' conclusion
Stroke was reported in a vast minority of HFrEF RCTs with heterogeneous definitions and no reference to underlying mechanisms. Despite under-reporting, stroke incidence is non-negligible. Stroke is associated with HFrEF-specific characteristics and outcomes, whereas it is not impacted by current HFrEF treatments.
Study context
- Population
- Patients with heart failure with reduced ejection fraction (HFrEF) enrolled in randomized controlled trials (RCTs) of pharmacologic and nonpharmacologic treatments
- Participants
- 75,327 patients · 30 studies · 61 arms
- Outcome
- Annualized stroke incidence
Pooled result
As reported in the abstract
Stroke incidence
1.1% (95% CI 0.9%-1.3%; I2 74%)
Further pooled results
Characteristics associated with stroke
- Higher NYHA class
- P < 0.001
- Lower SBP
- P < 0.001
- Diuretic use
- P = 0.001
- Diabetes
- P < 0.001
Treatments and stroke
- No association of RAAS inhibitors, beta-blockers, MRA or transcatheter mitral valve replacement with stroke
Stroke and other outcomes
- Stroke associated with higher risk of all-cause and CV mortality, HF hospitalization and ACS
- P < 0.001 for all
Reporting of stroke
- RCTs not reporting stroke outcomes (of 188)
- 158 (84.0%)
Original publication
Stroke in Heart Failure With Reduced Ejection Fraction. JACC Heart Fail. Published 12 March 2025. doi:10.1016/j.jchf.2024.12.008
Summarised from the published abstract; every number is checked against it