Stroke and Systemic Embolism and Other Adverse Outcomes of Heart Failure With Preserved and Reduced Ejection Fraction in Patients With Atrial Fibrillation (from the COmparison study of Drugs for symptom control and complication prEvention of Atrial Fibrillation [CODE-AF])

Seyong Chung, Tae Hoon Kim, Jae Sun Uhm, Myung Jin Cha, Jung Myung Lee, Junbeom Park, Jin Kyu Park, Ki Woon Kang, Jun Kim, Hyung Wook Park, Eue Keun Choi, Jin Bae Kim, Chang Soo Kim, Young Soo Lee, Jaemin Shim, Boyoung Joung

Research output: Contribution to journalArticle

Abstract

It is unknown whether heart failure (HF) with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF) carry a similar risk of stroke or systemic embolism (SE) and other outcomes in patients with nonvalvular atrial fibrillation (AF). A prospective, multicenter outpatient registry with echocardiographic data which enrolled 10,589 patients from June 2016 to May 2019 was analyzed. In this registry, 935 (8.8%) patients had HF, and the proportions of patients with HFpEF and HFrEF were 43.2% and 56.8%, respectively. During follow-up over 1.33 years, 11 (2.07 per 100 person-years [PYR]) and 5 (0.76 per 100 PYR) patients had stroke/SE in the HFpEF and HFrEF groups, respectively, whereas 102 patients (0.84 per 100 PYR) had these sequelae in the no-HF group. The HFpEF group had a significantly higher cumulative incidence of stroke/SE (p = 0.004) and risk of stroke/SE (adjusted hazard ratio [HR] 2.23, 95% confidence interval [CI] 1.19 to 4.18) than the no-HF group. The risk of stroke/SE in the HFpEF group compared with that in the no-HF group was consistently increased even in patients on oral anticoagulation therapy (adjusted HR 2.55, 95% CI 1.31 to 4.96). There was a correlation between larger left atrial size and risk of stroke/SE (adjusted HR 1.53, 95% CI 1.03 to 2.29), but not between reduced left ventricular ejection fraction and this risk. In conclusion, these results suggest that strict oral anticoagulation therapy helps reduce the risk of stroke/SE in patients with nonvalvular AF and HFpEF, especially in those with a larger left atrial size.

Original languageEnglish
Pages (from-to)68-75
Number of pages8
JournalAmerican Journal of Cardiology
Volume125
Issue number1
DOIs
Publication statusPublished - 2020 Jan 1

Fingerprint

Drug and Narcotic Control
Embolism
Atrial Fibrillation
Heart Failure
Stroke
Confidence Intervals
Registries
Stroke Volume
Outpatients
Incidence
Therapeutics

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Chung, Seyong ; Kim, Tae Hoon ; Uhm, Jae Sun ; Cha, Myung Jin ; Lee, Jung Myung ; Park, Junbeom ; Park, Jin Kyu ; Kang, Ki Woon ; Kim, Jun ; Park, Hyung Wook ; Choi, Eue Keun ; Kim, Jin Bae ; Kim, Chang Soo ; Lee, Young Soo ; Shim, Jaemin ; Joung, Boyoung. / Stroke and Systemic Embolism and Other Adverse Outcomes of Heart Failure With Preserved and Reduced Ejection Fraction in Patients With Atrial Fibrillation (from the COmparison study of Drugs for symptom control and complication prEvention of Atrial Fibrillation [CODE-AF]). In: American Journal of Cardiology. 2020 ; Vol. 125, No. 1. pp. 68-75.
@article{869aec8542864b0997283e3a44dbc8fe,
title = "Stroke and Systemic Embolism and Other Adverse Outcomes of Heart Failure With Preserved and Reduced Ejection Fraction in Patients With Atrial Fibrillation (from the COmparison study of Drugs for symptom control and complication prEvention of Atrial Fibrillation [CODE-AF])",
abstract = "It is unknown whether heart failure (HF) with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF) carry a similar risk of stroke or systemic embolism (SE) and other outcomes in patients with nonvalvular atrial fibrillation (AF). A prospective, multicenter outpatient registry with echocardiographic data which enrolled 10,589 patients from June 2016 to May 2019 was analyzed. In this registry, 935 (8.8{\%}) patients had HF, and the proportions of patients with HFpEF and HFrEF were 43.2{\%} and 56.8{\%}, respectively. During follow-up over 1.33 years, 11 (2.07 per 100 person-years [PYR]) and 5 (0.76 per 100 PYR) patients had stroke/SE in the HFpEF and HFrEF groups, respectively, whereas 102 patients (0.84 per 100 PYR) had these sequelae in the no-HF group. The HFpEF group had a significantly higher cumulative incidence of stroke/SE (p = 0.004) and risk of stroke/SE (adjusted hazard ratio [HR] 2.23, 95{\%} confidence interval [CI] 1.19 to 4.18) than the no-HF group. The risk of stroke/SE in the HFpEF group compared with that in the no-HF group was consistently increased even in patients on oral anticoagulation therapy (adjusted HR 2.55, 95{\%} CI 1.31 to 4.96). There was a correlation between larger left atrial size and risk of stroke/SE (adjusted HR 1.53, 95{\%} CI 1.03 to 2.29), but not between reduced left ventricular ejection fraction and this risk. In conclusion, these results suggest that strict oral anticoagulation therapy helps reduce the risk of stroke/SE in patients with nonvalvular AF and HFpEF, especially in those with a larger left atrial size.",
author = "Seyong Chung and Kim, {Tae Hoon} and Uhm, {Jae Sun} and Cha, {Myung Jin} and Lee, {Jung Myung} and Junbeom Park and Park, {Jin Kyu} and Kang, {Ki Woon} and Jun Kim and Park, {Hyung Wook} and Choi, {Eue Keun} and Kim, {Jin Bae} and Kim, {Chang Soo} and Lee, {Young Soo} and Jaemin Shim and Boyoung Joung",
year = "2020",
month = "1",
day = "1",
doi = "10.1016/j.amjcard.2019.09.035",
language = "English",
volume = "125",
pages = "68--75",
journal = "American Journal of Cardiology",
issn = "0002-9149",
publisher = "Elsevier Inc.",
number = "1",

}

Stroke and Systemic Embolism and Other Adverse Outcomes of Heart Failure With Preserved and Reduced Ejection Fraction in Patients With Atrial Fibrillation (from the COmparison study of Drugs for symptom control and complication prEvention of Atrial Fibrillation [CODE-AF]). / Chung, Seyong; Kim, Tae Hoon; Uhm, Jae Sun; Cha, Myung Jin; Lee, Jung Myung; Park, Junbeom; Park, Jin Kyu; Kang, Ki Woon; Kim, Jun; Park, Hyung Wook; Choi, Eue Keun; Kim, Jin Bae; Kim, Chang Soo; Lee, Young Soo; Shim, Jaemin; Joung, Boyoung.

In: American Journal of Cardiology, Vol. 125, No. 1, 01.01.2020, p. 68-75.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Stroke and Systemic Embolism and Other Adverse Outcomes of Heart Failure With Preserved and Reduced Ejection Fraction in Patients With Atrial Fibrillation (from the COmparison study of Drugs for symptom control and complication prEvention of Atrial Fibrillation [CODE-AF])

AU - Chung, Seyong

AU - Kim, Tae Hoon

AU - Uhm, Jae Sun

AU - Cha, Myung Jin

AU - Lee, Jung Myung

AU - Park, Junbeom

AU - Park, Jin Kyu

AU - Kang, Ki Woon

AU - Kim, Jun

AU - Park, Hyung Wook

AU - Choi, Eue Keun

AU - Kim, Jin Bae

AU - Kim, Chang Soo

AU - Lee, Young Soo

AU - Shim, Jaemin

AU - Joung, Boyoung

PY - 2020/1/1

Y1 - 2020/1/1

N2 - It is unknown whether heart failure (HF) with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF) carry a similar risk of stroke or systemic embolism (SE) and other outcomes in patients with nonvalvular atrial fibrillation (AF). A prospective, multicenter outpatient registry with echocardiographic data which enrolled 10,589 patients from June 2016 to May 2019 was analyzed. In this registry, 935 (8.8%) patients had HF, and the proportions of patients with HFpEF and HFrEF were 43.2% and 56.8%, respectively. During follow-up over 1.33 years, 11 (2.07 per 100 person-years [PYR]) and 5 (0.76 per 100 PYR) patients had stroke/SE in the HFpEF and HFrEF groups, respectively, whereas 102 patients (0.84 per 100 PYR) had these sequelae in the no-HF group. The HFpEF group had a significantly higher cumulative incidence of stroke/SE (p = 0.004) and risk of stroke/SE (adjusted hazard ratio [HR] 2.23, 95% confidence interval [CI] 1.19 to 4.18) than the no-HF group. The risk of stroke/SE in the HFpEF group compared with that in the no-HF group was consistently increased even in patients on oral anticoagulation therapy (adjusted HR 2.55, 95% CI 1.31 to 4.96). There was a correlation between larger left atrial size and risk of stroke/SE (adjusted HR 1.53, 95% CI 1.03 to 2.29), but not between reduced left ventricular ejection fraction and this risk. In conclusion, these results suggest that strict oral anticoagulation therapy helps reduce the risk of stroke/SE in patients with nonvalvular AF and HFpEF, especially in those with a larger left atrial size.

AB - It is unknown whether heart failure (HF) with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF) carry a similar risk of stroke or systemic embolism (SE) and other outcomes in patients with nonvalvular atrial fibrillation (AF). A prospective, multicenter outpatient registry with echocardiographic data which enrolled 10,589 patients from June 2016 to May 2019 was analyzed. In this registry, 935 (8.8%) patients had HF, and the proportions of patients with HFpEF and HFrEF were 43.2% and 56.8%, respectively. During follow-up over 1.33 years, 11 (2.07 per 100 person-years [PYR]) and 5 (0.76 per 100 PYR) patients had stroke/SE in the HFpEF and HFrEF groups, respectively, whereas 102 patients (0.84 per 100 PYR) had these sequelae in the no-HF group. The HFpEF group had a significantly higher cumulative incidence of stroke/SE (p = 0.004) and risk of stroke/SE (adjusted hazard ratio [HR] 2.23, 95% confidence interval [CI] 1.19 to 4.18) than the no-HF group. The risk of stroke/SE in the HFpEF group compared with that in the no-HF group was consistently increased even in patients on oral anticoagulation therapy (adjusted HR 2.55, 95% CI 1.31 to 4.96). There was a correlation between larger left atrial size and risk of stroke/SE (adjusted HR 1.53, 95% CI 1.03 to 2.29), but not between reduced left ventricular ejection fraction and this risk. In conclusion, these results suggest that strict oral anticoagulation therapy helps reduce the risk of stroke/SE in patients with nonvalvular AF and HFpEF, especially in those with a larger left atrial size.

UR - http://www.scopus.com/inward/record.url?scp=85074891226&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85074891226&partnerID=8YFLogxK

U2 - 10.1016/j.amjcard.2019.09.035

DO - 10.1016/j.amjcard.2019.09.035

M3 - Article

C2 - 31699363

AN - SCOPUS:85074891226

VL - 125

SP - 68

EP - 75

JO - American Journal of Cardiology

JF - American Journal of Cardiology

SN - 0002-9149

IS - 1

ER -