Cardiac complications after stroke: protocol for a systematic review and meta-analysis

BMJ Open. 2018 May 24;8(5):e021416. doi: 10.1136/bmjopen-2017-021416.


Introduction: Stroke is the second most common cause of death after ischaemic heart diseases and the third leading cause of disability worldwide. The contribution of cardiac complications to the mortality of patients with stroke is variable across studies, ranging from 12.5% to 22.7%. Many of these cardiac complications are preventable, and early recognition and adequate management guided by appropriate up-to-date knowledge of their relative incidence and fatality can help to improve patients' outcomes. This systematic review aims to summarise the available data on the burden of cardiac complications after stroke.

Methods and analysis: This review will include all cross-sectional, case-control and cohort studies and clinical trials published between 1 January 1950 and 31 December 2017, involving adults and/or children, and reporting on the prevalence, the incidence and/or the mortality of cardiac complications after stroke. Two reviewers will independently screen titles and abstracts of records retrieved from PubMed, Excerpta Medica Database, ISI Web of Science and the Cumulative Index to Nursing and Allied Health Literature for eligibility, and then assess the risk of bias and quality of reporting to select the studies which will be included. All authors will contribute to the retrieval of full texts of eligible records and data extraction. Heterogeneity across studies will be evaluated by the χ2 test on Cochran's Q statistic. Study-specific estimates of the prevalence, incidence and mortality of cardiac complications after stroke across studies will be pooled through random-effect or fixed-effect meta-analysis depending on the source of the heterogeneity, after stabilising the variance of individual studies using the Freeman-Tukey double arcsine transformation. Visual analysis of funnel plots and Egger's test will be done to detect small-study effect.

Ethics and dissemination: This review and meta-analysis will be based on published data and will therefore not require a specific ethical clearance. The results will be published in peer-reviewed journals.

Prospero registration number: CRD42018082551.

Keywords: cardiac complications; epidemiology; mortality; stroke; systematic review.

MeSH terms

  • Adult
  • Child
  • Heart Diseases* / etiology
  • Heart Diseases* / mortality
  • Humans
  • Meta-Analysis as Topic
  • Research Design
  • Stroke* / complications
  • Stroke* / mortality
  • Systematic Reviews as Topic