Impact of Patent Foramen Ovale on Ischemic Stroke Outcomes in Patients Aged 65 and Older: A Retrospective Cohort Study

Introduction This study evaluated the clinical characteristics, outcomes, and management implications associated with patent foramen ovale (PFO) in patients aged 65 and older who presented with ischemic stroke at a single center. Methods This retrospective study included patients aged 65 and older who were admitted with ischemic stroke between 2017 and 2019 and were followed for three years. Patients were categorized based on the presence or absence of a PFO identified during the index hospitalization. Outcomes included events during the index admission and ischemic stroke readmissions during follow-up. Continuous variables were analyzed using the Student's t-test, and categorical variables were compared using the Pearson Chi-square test. Binary logistic regression was used to identify independent predictors of ischemic stroke recurrence. Results A total of 1,090 patients were included. Of these, 116 patients (10.6%) had a PFO and 974 (89.4%) did not. The mean age was 74.8 years in the PFO group and 75.9 years in the non-PFO group. Comorbidities were similar between groups. The three-year ischemic stroke readmission rate was 8.9% in the PFO group and 11.2% in the non-PFO group (P = 0.36). Hypertension was independently associated with ischemic stroke recurrence (Odds Ratio = 3.88; 95% CI: 1.1-17; P = 0.04). No patients with PFO underwent closure during follow-up. Conclusion Among patients aged 65 and older admitted with ischemic stroke, the presence of PFO was not associated with differences in three-year stroke readmission rates or length of stay during the index hospitalization. In this cohort, ischemic stroke recurrence was associated with hypertension rather than PFO status.