PURPOSE: Systolic heart failure(SHF) is the second most common cause of cerebrovascular events (CVE) in the US after atrial fibrillation. Previous studies have measured the annual incidence of CVE in patients with SHF with values as high as 5.5%. In CAD, the annual incidence is 3.4%, where as in healthy men, it is 0.95%. These observations were conducted prior to the current era of neurohormonal blocking agents as standard SHF therapy. The COMET trial compared carvedilol to metoprolol tartrate in SHF and revealed a 65% stroke reduction in the carvedilol cohort. We aimed to ascertain the incidence of CVE in a rural indigent SHF population receiving standard medical therapy including beta blockers.
METHODS: Four hundred eighteen patients followed in a SHF disease management program in rural South Louisiana were prospectively screened from January 2005 to December 2005 at each visit for the occurance of a new stroke or TIA as ascertained by the presence of any one of the five warning signs of CVE as established by the NINDS.
RESULTS: The 1 year incidence of CVE is 1.91% (n=8) in the population. All of these were CVA’s. There were no significant differences between groups regarding mean age, mean EF, gender, race, % atrial fibrillation, % history of CVE, systolic blood pressure, NYHA class, payment status, % smokers, % diabetes, aspirin usage or usage of Ace inhibitors and beta blockers. Medium income of the population is $11,800/year. Beta blocker use (>95% carvedilol usage in both groups) is 100% in the CVE group vs. 97.8% in the non CVE group (n=410). Ace inhibitor usage was 100% in the CVE group vs. 96.1% in the non CVE group.
CONCLUSION: CVE incidence in a rural indigent SHF population on standard medical therapy is higher than the general population but lower than previously reported in heart failure populations.
CLINICAL IMPLICATIONS: Whether this decreased incidence of CVE is due to the widespread usage of standard neurohormonal blocking agents or other factors in this population requires further study.
DISCLOSURE: Lee Arcement, None.