Related Experiment Video

Updated: Aug 1, 2025

Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
28:13

Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation

Published on: February 26, 2013

33.5K

Risks of Heart Failure, Stroke, and Bleeding in Atrial Fibrillation According to Heart Failure Phenotypes

Riccardo M Inciardi1, Robert P Giugliano2, Jeong-Gun Park2

  • 1Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Division of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health; ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy.

JACC. Clinical Electrophysiology
|April 26, 2023
PubMed

Insights

Patients with atrial fibrillation (AF) and heart failure (HF) face higher risks of HF events than stroke or bleeding. Heart failure with reduced ejection fraction (HFrEF) carries a greater HF event risk than heart failure with preserved ejection fraction (HFpEF).

Area of Science:

  • Cardiology
  • Clinical Research
  • Atrial Fibrillation Management

Background:

  • The comparative risks of heart failure (HF) events versus stroke/systemic embolic events (SEE) or major bleeding (MB) in patients with atrial fibrillation (AF), stratified by HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF), remain understudied.
  • Understanding these risks is crucial for optimizing anticoagulation and HF management strategies in this complex patient population.

Purpose of the Study:

  • To assess HF outcomes in AF patients based on HF history and HF phenotypes (HFrEF vs. HFpEF).
  • To compare the incidence of HF hospitalizations (HHF) or HF death with the rates of fatal/nonfatal stroke/SEE and MB in AF patients.
  • To evaluate subsequent mortality risk following HHF, stroke/SEE, or MB.

Main Methods:

  • Analysis of patients from the ENGAGE-AF TIMI 48 trial.
  • Assessment of cumulative incidence for HHF or HF death, compared with stroke/SEE and MB rates.
  • Median follow-up duration of 2.8 years.

Main Results:

  • Patients with a history of HF experienced higher rates of HHF or HF death (4.95 per 100 person-years) compared to stroke/SEE (1.77) and MB (2.66).
  • HFrEF patients had a significantly higher rate of HHF or HF death than HFpEF patients (7.15 vs. 3.65).
  • Rates of stroke/SEE and MB were similar between HFrEF and HFpEF phenotypes. Mortality following HHF was higher than following stroke/SEE or MB.

Conclusions:

  • AF patients with HF, irrespective of ejection fraction, exhibit a heightened risk of HF events and subsequent mortality compared to stroke/SEE or MB.
  • HFrEF is associated with a greater risk of HF events than HFpEF, although risks for stroke/SEE and MB are comparable between these HF phenotypes.
Abstract

Keywords:
atrial fibrillationheart failuremajor bleedingstroke/systemic embolic events

More Related Videos

The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation23:33

The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation

Published on: February 28, 2012

83.7K
Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation08:10

Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation

Published on: July 20, 2022

1.7K

Related Concept Videos

Pathophysiology of Heart Failure01:17

Pathophysiology of Heart Failure

Heart failure (HF) is a progressive syndrome involving ventricles that leads to inadequate cardiac output. It can be classified based on location and output or ejection fraction. Ejection fraction (EF) is an essential measurement in the diagnosis and surveillance of HF. Reduced EF corresponds to systolic heart failure (HFrEF). However, HF with preserved ejection fraction (HFpEF) is becoming increasingly prevalent. Also known as diastolic HF, this form of HF is related to aging. The...
1.7K
Heart Failure IV: Classification and Diagnostic Evaluation01:30

Heart Failure IV: Classification and Diagnostic Evaluation

Heart failure can be classified in various ways, with the most common classifications based on physical activity limitations, disease progression, severity, and treatment strategies.The Functional Classification of Heart Failure divides patients into four categories based on physical activity limitation due to symptom burden.Class I: Patients in this class have cardiac disease but no physical activity limitations. Ordinary activities like walking, climbing stairs, or routine tasks do not cause...
22
Heart Failure I: Introduction01:27

Heart Failure I: Introduction

Heart failure refers to a clinical syndrome caused by structural or functional cardiac disorders that prevent the heart from pumping an adequate amount of blood to meet the body's metabolic needs. This condition often arises from myocardial infarction or ischemia, leading to decreased cardiac output, reduced tissue perfusion, impaired gas exchange, fluid volume imbalance, and decreased functional ability.Heart failure can result from disruptions in the mechanisms that regulate cardiac output...
28
Disturbances in Heart Rhythm01:29

Disturbances in Heart Rhythm

Arrhythmia or dysrhythmia refers to an abnormal heart rhythm caused by a defect in the heart's conduction system. It can cause the heart to beat irregularly, too quickly, or too slowly, leading to symptoms like chest pain, shortness of breath, and fainting. Factors such as stress, caffeine, alcohol, nicotine, cocaine, certain drugs, congenital defects, diseases, and electrolyte abnormalities can trigger arrhythmias.
Arrhythmias are categorized by their speed, rhythm, and origin. A slow heart...
1.1K
Heart Failure II: Pathophysiology01:29

Heart Failure II: Pathophysiology

Systolic Heart Failure and Compensatory MechanismsSystolic heart failure (also termed HFrEF, Heart Failure with Reduced Ejection Fraction) is the most prevalent type of heart filure. It results in a decreased volume of blood being pumped from the ventricle. The aortic arch and carotid sinuses have baroreceptors that detect reduced blood pressure, triggering the sympathetic nervous system (SNS) to release epinephrine and norepinephrine. Initially, this response aims to boost heart rate and...
19
Heart Failure III: Clinical Manifestations01:26

Heart Failure III: Clinical Manifestations

Heart failure (HF) manifests primarily as dyspnea, fatigue, and fluid retention, resulting in peripheral and pulmonary edema. Symptoms may vary depending on which ventricle is more affected, left or right.Left-Sided Heart FailureAlso known as left ventricular failure, this condition results from the left ventricle's inability to fill or eject sufficient blood into the systemic circulation. It leads to pulmonary congestion, which occurs when the left ventricle fails to eject blood effectively...
29