Stroke and systemic embolism in patients with atrial fibrillation and heart failure according to heart failure type. (25th February 2021)

• Record Type: Journal Article
• Authors: Uhm, Jae‐Sun; Kim, Jun; Yu, Hee Tae; Kim, Tae‐Hoon; Lee, So‐Ryoung; Cha, Myung‐Jin; Choi, Eue‐Keun; Lee, Jung Myung; Kim, Jin‐Bae; Park, Junbeom; Park, Jin‐Kyu; Kang, Ki‐Woon; Shim, Jaemin; Park, Hyung Wook; Lee, Young Soo; Kim, Chang‐Soo; Mun, Ji Eun; Son, Nak‐Hoon; Joung, Boyoung
• Is Part Of: ESC heart failure. Volume 8:Number 2(2021)
• Page Start: 1582
• Page End: 1589
• Publication Date: 2021-02-25
• Subjects: Atrial fibrillation -- Bleeding -- Ejection fraction -- Heart failure -- Stroke -- Systemic embolism; Heart failure -- Periodicals; 616.129005
• DOI: 10.1002/ehf2.13264
• Languages: English
• ISSNs: 2055-5822

Abstract

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 CHA2 DS2 ‐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.