Stroke and systemic embolism in patients with atrial fibrillation and heart failure according to heart failure type

Abstract

Aims This study aimed to elucidate the risk for stroke and systemic embolism (SE) in patients with atrial fibrillation and heart failure (HF) according to HF type. Methods and results A total of 10 780 patients with atrial fibrillation were enrolled in a multicentre prospective registry and divided according to HF type: no-HF, HF with preserved ejection fraction (EF) (HFpEF), HF with mid-range EF (HFmrEF), and HF with reduced EF (HFrEF). Each group included 237 age-matched and sex-matched patients (age, 69.0 ± 10.3 years; men, 69.6%). The baseline characteristics, cumulative incidence, and hazard ratios for stroke/SE and major bleeding were compared across the groups. Patients with HF accounted for 10.3% of the total population; HFpEF, HFmrEF, and HFrEF represented 43.7%, 23.6%, and 32.7% of the patients with HF, respectively. The CHA 2 DS 2-VASc score was significantly higher in the HFpEF, HFmrEF, and HFrEF groups than in the no-HF group. The annual stroke/SE incidence rates were 2.8%, 0.7%, 1.1%, and 0.9% in the HFpEF, HFmrEF, HFrEF, and no-HF groups, respectively. The cumulative incidence of stroke/SE was significantly highest in the HFpEF group at 22.8 ± 10.0 months (P = 0.020). The stroke/SE risk was higher in the HFpEF group than in the HFmrEF and HFrEF groups (hazard ratio, 3.192; 95% confidence interval, 1.039-9.810; P = 0.043). E/e' value was an independent risk factor for stroke/SE. There were no significant differences in the incidence of major bleeding across the groups. Conclusions The stroke/SE risk was the highest in the HFpEF group and comparable between the HFmrEF and HFrEF groups.

Stroke and Thromboembolism in Patients with Heart Failure and Sinus Rhythm: A Matter of Risk Stratification?

“…Relative to HF with reduced ejection fraction (HFrEF), HFpEF may be associated with greater inflammation and oxidative stress and a higher risk of (AF-related) ischemic stroke (10). Indeed, in an age-and sex-matched registry study of Korean patients with AF, the annual incidence of stroke and systemic embolism in patients with HFpEF and HFrEF was 2.8% and 1.1%, respectively (11). Notably, the severity of HF symptoms may be associated…”

Stroke and Bleeding Risk Assessment in Atrial Fibrillation: Where Are We Now?

“… 11) In a recent study from South Korea, a total of 10,780 AF patients were enrolled and divided according to HF type: no-HF (n=9,666), HFpEF (LVEF ≥50%; n=487), HF with mid-range ejection fraction (HFmrEF; LVEF 40–49%; n=263), and HFrEF (LVEF <40%; n=364). 12) The stroke/systemic embolism (SE) risk was higher in the HFpEF group than in the HFmrEF and HFrEF groups (hazard ratio [HR], 3.192; p=0.043), with E/e′ value as an independent risk factor. 12) Therefore, in ACCP and ESC guidelines, patients with either HFrEF or HFpEF would assigned 1 point for the “C” component.…”

“… 12) The stroke/systemic embolism (SE) risk was higher in the HFpEF group than in the HFmrEF and HFrEF groups (hazard ratio [HR], 3.192; p=0.043), with E/e′ value as an independent risk factor. 12) Therefore, in ACCP and ESC guidelines, patients with either HFrEF or HFpEF would assigned 1 point for the “C” component.…”

Essen Stroke Risk Score Predicts Clinical Outcomes in Heart Failure Patients with Preserved Ejection Fraction: Evidence from the TOPCAT trial

“…1 Although whether HF itself is a risk factor for stroke without the influence of atrial fibrillation (AF) is still controversial, recent studies have shown that stroke is considered one of the devastating outcomes in HF patients regardless of left ventricular ejection fraction (LVEF). 2 In addition, the presence of HF is also associated with worse outcomes and mortality after stroke.…”