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The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
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Atrial fibrillation in heart failure: stroke risk stratification and anticoagulation

JoEllyn M Abraham1, Stuart J Connolly

  • 1Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, J2-2, Cleveland, OH, 44195, USA, abrahaj3@ccf.org.

Heart Failure Reviews
|January 22, 2014
PubMed

Insights

Patients with atrial fibrillation and heart failure face high stroke risk. New oral anticoagulants offer options, but renal function and bleeding risk require careful consideration for effective stroke prevention.

Area of Science:

  • Cardiology
  • Neurology
  • Pharmacology

Background:

  • Atrial fibrillation and heart failure significantly increase stroke risk, impacting patient morbidity and mortality.
  • The CHADS₂ score, while common, has limitations in capturing all stroke risk factors.
  • Diastolic heart failure poses a stroke risk comparable to systolic heart failure.

Purpose of the Study:

  • To review stroke risk in patients with co-existing atrial fibrillation and heart failure.
  • To evaluate the role of novel oral anticoagulants in this patient population.
  • To highlight considerations for anticoagulation therapy in heart failure patients with atrial fibrillation.

Main Methods:

  • Literature review of stroke risk factors in atrial fibrillation and heart failure.
  • Analysis of current guidelines and evidence regarding novel oral anticoagulants (dabigatran, rivaroxaban, apixaban).
  • Discussion of patient-specific factors influencing anticoagulation decisions, including renal function and bleeding risk.

Main Results:

  • Novel oral anticoagulants demonstrate potential utility in heart failure patients with atrial fibrillation.
  • Dose adjustments for renal insufficiency are necessary for these agents.
  • Contraindications exist for advanced renal disease.

Conclusions:

  • Anticoagulation is crucial for stroke risk reduction in atrial fibrillation and heart failure patients.
  • Careful assessment of bleeding risk is paramount before initiating anticoagulation.
  • Individualized treatment plans considering renal function and specific anticoagulants are essential.

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