| Summary: | <b>Background and Purpose</b>. Heart failure (HF) is considered one of the major risk factors associated with the severity of acute ischemic stroke(AIS). The risk factors associated with stroke severity in AIS with a history of HF is not fully understood. <b>Methods</b>. A prospectively maintained database from comprehensive stroke centers in PRISMA Health Upstate Sc, was analyzed for patients with AIS and a history of HF from January 2010 to 30 June 2016. The primary outcome was risk factors associated with a National Institute of Health Stroke Scale score (NIHSS) < 7 indicating lower severity and a score ≥ 7 indicating high severity for 65–74 age category and ≥75 years age category for AIS-HF patients. Univariate analysis was used to determine risk factors based on age categories and stroke severities, while multivariable analysis was used to adjust for the effect of confounding variables. <b>Results</b>: A total 367 AIS-HF patients were identified in this study, 113 patients were between 65–74 years old, while 254 patients were in the ≥75 years old age category. In the adjusted analysis for 65–74 age category, history of smoking (OR = 0.105, 95% Confidence interval (CI): 0.018–0.614, <i>p</i> = 0.012), triglycerides (Odd ratio(OR) = 0.993, 95% (CI): 0.987–0.999, <i>p</i> = 0.019), and International Normalized Ratio (INR) (OR = 0.454, 95% CI: 0.196–1.050, <i>p</i> = 0.045), and direct admission treatment (OR = 0.355, 95% CI: 0.137–0.920, <i>p</i> = 0.033) were associated with a lower stroke severity, elevated heart rate (OR = 1.032, 95% CI: 1.009–1.057, <i>p</i> = 0.007) was associated with a higher stroke severity. For the ≥75 years old age category, previous stroke (OR = 2.297, 95% CI: 1.171–9.852, <i>p</i> = 0.024), peripheral vascular disease (OR = 6.784, 95% CI: 1.242–37.065, <i>p</i> = 0.027), heart rate (OR = 1.035, 95% CI: 1.008–1.063, <i>p</i> = 0.012), and systolic blood pressure (OR = 1.023, 95% CI: 1.005–1.041, <i>p</i> = 0.012) were associated with a higher severe stroke severity. <b>Conclusions</b>: After adjusting for the effect of potential confounders, more risk factors were associated with a high severity of stroke among ≥75 years old compared with 65–74 years old AIS-HF patients. Elevated heart rate was an independent risk factor associated with stroke severity in 65–74 and ≥75 years old AIS-HF patients. Elevated heart rate and other identified risk factors should be managed to reduce stroke severity among elderly AIS-HF patients.
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