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

Jae-Sun Uhm1, Jun Kim2, Hee Tae Yu1

  • 1Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, South Korea.

ESC Heart Failure
|February 26, 2021
PubMed

Insights

Patients with atrial fibrillation and heart failure (HF) face varying stroke risks. Heart failure with preserved ejection fraction (HFpEF) presents the highest risk for stroke and systemic embolism (SE), while other HF types show comparable risks.

Area of Science:

  • Cardiology
  • Neurology
  • Internal Medicine

Background:

  • Atrial fibrillation (AF) and heart failure (HF) are common comorbidities.
  • Understanding stroke and systemic embolism (SE) risk stratification in AF patients with different HF types is crucial for clinical management.

Purpose of the Study:

  • To investigate the risk of stroke/SE in patients with atrial fibrillation (AF) stratified by heart failure (HF) type: no-HF, HF with preserved ejection fraction (HFpEF), HF with mid-range ejection fraction (HFmrEF), and HF with reduced ejection fraction (HFrEF).

Main Methods:

  • A prospective registry of 10,780 AF patients was analyzed.
  • Patients were categorized into no-HF, HFpEF, HFmrEF, and HFrEF groups.
  • Baseline characteristics, cumulative incidence, and hazard ratios for stroke/SE and major bleeding were compared.

Main Results:

  • The CHA 2 DS 2 -VASc score was higher in all HF groups compared to no-HF.
  • Annual stroke/SE incidence rates were 2.8% (HFpEF), 0.7% (HFmrEF), 1.1% (HFrEF), and 0.9% (no-HF).
  • HFpEF group showed the highest cumulative incidence of stroke/SE and a significantly higher risk compared to HFmrEF and HFrEF groups. E/e' value was an independent risk factor for stroke/SE. Major bleeding incidence did not differ significantly across groups.

Conclusions:

  • Heart failure with preserved ejection fraction (HFpEF) is associated with the highest risk of stroke/SE in patients with atrial fibrillation.
  • The risk of stroke/SE is comparable between HF with mid-range ejection fraction (HFmrEF) and HF with reduced ejection fraction (HFrEF) groups.
  • E/e' value serves as an independent predictor for stroke/SE in this population.
Abstract

Keywords:
Atrial fibrillationBleedingEjection fractionHeart failureStrokeSystemic embolism

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