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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
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Heart Failure and Stroke Risk in Atrial Fibrillation: Temporal Trends From a Nationwide Cohort Study

Eero Jalli1,2, Ville Langén2,3, Jussi Jaakkola4

  • 1Heart Centre Turku University Hospital and University of Turku Finland.

Journal of the American Heart Association
|July 14, 2025
PubMed

Insights

Heart failure (HF) significantly increases ischemic stroke (IS) risk in atrial fibrillation (AF) patients. This risk has decreased, especially for those without prior myocardial infarction (MI), but HF remains a key stroke factor for patients with a history of MI.

Area of Science:

  • Cardiology
  • Neurology
  • Public Health

Background:

  • Heart failure (HF) is a known risk factor for ischemic stroke (IS) in patients with atrial fibrillation (AF).
  • Medical advancements have improved AF and HF management, but their impact on HF-related stroke risk in AF patients is unclear.
  • This study investigates temporal trends in HF-associated IS risk among AF patients.

Purpose of the Study:

  • To evaluate temporal trends in heart failure-related ischemic stroke risk among patients diagnosed with atrial fibrillation.
  • To determine if changes in AF and HF management have modified the association between heart failure and stroke risk in atrial fibrillation patients.

Main Methods:

  • Nationwide retrospective cohort study using the Finnish AntiCoagulation in Atrial Fibrillation (FinACAF) registry-linkage.
  • Inclusion of all patients in Finland diagnosed with incident AF between 2007 and 2018.
  • Analysis of ischemic stroke rates and their association with heart failure over the study period.

Main Results:

  • A total of 229,565 patients with incident AF were identified; 17.4% had HF at AF diagnosis.
  • Crude IS rates declined in both HF and non-HF groups. The association between HF and IS risk attenuated from 30-50% higher (2007-2010) to 10-15% higher (2015-2018).
  • This reduction was primarily in patients without prior myocardial infarction (MI); stroke risk remained unchanged for HF patients with prior MI.

Conclusions:

  • Stroke risk associated with HF has decreased in AF patients, particularly those without a history of MI.
  • Heart failure continues to be a significant stroke risk factor for AF patients with a history of myocardial infarction.
  • Ongoing monitoring and tailored management strategies are crucial for mitigating stroke risk in this population.
Abstract

Keywords:
atrial fibrillationcohort studyheart failurestroke

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