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Age-Dependent Association between Heart Failure and Stroke Risk in Atrial Fibrillation: A Nationwide Cohort Study
Eero Jalli1, Ville Langén2,3, Jussi Jaakkola4
1Department of Internal Medicine, Satasairaala Hospital Pori, Finland and University of Turku Turku Finland.
Journal of the American Heart Association
|May 6, 2026
Summary
Heart failure increases stroke risk in atrial fibrillation (AF) patients, but this association is strongest in younger individuals. This finding is crucial for oral anticoagulation decisions, especially for younger AF patients.
Area of Science:
- Cardiology
- Neurology
- Public Health
Background:
- Atrial fibrillation (AF) is a primary cause of ischemic stroke.
- Age is a significant risk factor for stroke in AF patients and modifies other risk factors.
- Limited data exist on how age impacts the association between heart failure (HF) and stroke risk in AF patients.
Purpose of the Study:
- To investigate the age-dependent association between heart failure (HF) and ischemic stroke risk in patients with atrial fibrillation (AF).
Main Methods:
- A nationwide retrospective cohort study (FinACAF) of 229,565 patients with new-onset AF from 2007-2018.
- Utilized comprehensive Finnish healthcare registries for data collection.
- Calculated incidence rate ratios for stroke comparing patients with and without HF across different age groups.
Main Results:
- The prevalence of HF was significantly higher in older AF patients (38.7%) compared to younger ones (4.3%).
- The association between HF and ischemic stroke was most pronounced in younger patients (IRR ≥2.0 for <60 years) and decreased with age.
- A significant interaction between age and the HF-stroke association was observed (P<0.001).
Conclusions:
- Heart failure poses a greater risk for ischemic stroke in younger AF patients compared to older individuals.
- These findings underscore the importance of considering heart failure in oral anticoagulation decisions, particularly for younger AF patients.
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