Predicting Stroke in Heart Failure and Preserved Ejection Fraction Without Atrial Fibrillation.

Area of Science:

• Cardiology
• Neurology
• Clinical Trials

Background:

• Stroke risk in heart failure with preserved ejection fraction (HFpEF) without atrial fibrillation (AF) is not well understood.
• Predicting stroke risk in this specific patient population remains challenging.

Purpose of the Study:

• To validate a simple risk prediction model for stroke in patients with HFpEF and no history of AF.
• To assess the stroke risk in HFpEF patients without AF using a validated model.

Main Methods:

• Validated a 3-variable risk model (prior stroke, insulin-treated diabetes, NT-proBNP) in pooled data from the I-Preserve and PARAGON-HF trials.
• Included 5126 patients with HFpEF and no baseline AF.

Main Results:

• The validated risk model demonstrated good discrimination (C-index 0.81).
• Stroke incidence was 10.5 per 1000 patient-years in the overall HFpEF without AF cohort.
• Patients in the highest risk tertile had a stroke rate (17.7 per 1000 patient-years) comparable to patients with AF on anticoagulation.

Conclusions:

• A simple risk score effectively identifies high-stroke-risk individuals within the HFpEF without AF population.
• Findings suggest that prophylactic anticoagulation might be considered for high-risk individuals, warranting prospective investigation.