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Patients with Heart Failure and Preserved Ejection Fraction Are at Risk of Gastrointestinal Bleeding

Lore Schrutka1, Benjamin Seirer1, Franz Duca1

  • 1Division of Cardiology, Medical University of Vienna, A-1090 Vienna, Austria.

Journal of Clinical Medicine
|August 21, 2019
PubMed

Insights

Patients with heart failure with preserved ejection fraction (HFpEF) on oral anticoagulation (OAC) face a high risk of bleeding, particularly gastrointestinal (GI) bleeding. Mean right atrial pressure (mRAP) predicts GI bleeding and improves risk assessment beyond the HAS-BLED score.

Area of Science:

  • Cardiology
  • Internal Medicine
  • Pharmacology

Background:

  • Two-thirds of patients with heart failure with preserved ejection fraction (HFpEF) require oral anticoagulation (OAC) to prevent thromboembolic events.
  • Limited evidence exists on the safety of OAC in HFpEF patients, particularly concerning bleeding risks.

Purpose of the Study:

  • To describe the incidence and characteristics of bleeding events in a large cohort of HFpEF patients.
  • To identify predictors of bleeding events, especially gastrointestinal (GI) bleeding, in this population.

Main Methods:

  • Prospective cohort study of 328 HFpEF patients, with data on OAC use (VKA or NOACs) and bleeding events.
  • Follow-up for a median of 42 months to record bleeding occurrences.
  • Analysis of predictors including the HAS-BLED score and mean right atrial pressure (mRAP).

Main Results:

  • Patients on OAC experienced significantly more bleeding events (23.1%) compared to those not on OAC (4.3%).
  • Gastrointestinal (GI) bleeding was a major driver of events.
  • The HAS-BLED score was the strongest independent predictor of overall bleeding. Mean right atrial pressure (mRAP) and HAS-BLED score predicted GI bleeding, with mRAP providing additional prognostic value.

Conclusions:

  • HFpEF patients treated with OAC are at a high risk for GI bleeding.
  • Elevated mRAP, indicative of advanced disease, is a significant predictor of GI bleeding.
  • mRAP enhances risk stratification for GI bleeding beyond the established HAS-BLED score.
Abstract

Keywords:
bleedingheart failurehemodynamicsoral anticoagulation

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