Stroke and systemic embolism in patients with atrial fibrillation and heart failure according to heart failure type

Jae Sun Uhm, Jun Kim, Hee Tae Yu, Tae Hoon Kim, So Ryoung Lee, Myung Jin Cha, Eue Keun Choi, Jung Myung Lee, Jin Bae Kim, Junbeom Park, Jin Kyu Park, Ki Woon Kang, Jaemin Shim, Hyung Wook Park, Young Soo Lee, Chang Soo Kim, Ji Eun Mun, Nak Hoon Son, Boyoung Joung

Research output: Contribution to journalArticlepeer-review

Abstract

Aims: This study aimed to elucidate the risk for stroke and systemic embolism (SE) in patients with atrial fibrillation and heart failure (HF) according to HF type. Methods and results: A total of 10 780 patients with atrial fibrillation were enrolled in a multicentre prospective registry and divided according to HF type: no-HF, HF with preserved ejection fraction (EF) (HFpEF), HF with mid-range EF (HFmrEF), and HF with reduced EF (HFrEF). Each group included 237 age-matched and sex-matched patients (age, 69.0 ± 10.3 years; men, 69.6%). The baseline characteristics, cumulative incidence, and hazard ratios for stroke/SE and major bleeding were compared across the groups. Patients with HF accounted for 10.3% of the total population; HFpEF, HFmrEF, and HFrEF represented 43.7%, 23.6%, and 32.7% of the patients with HF, respectively. The CHA2DS2-VASc score was significantly higher in the HFpEF, HFmrEF, and HFrEF groups than in the no-HF group. The annual stroke/SE incidence rates were 2.8%, 0.7%, 1.1%, and 0.9% in the HFpEF, HFmrEF, HFrEF, and no-HF groups, respectively. The cumulative incidence of stroke/SE was significantly highest in the HFpEF group at 22.8 ± 10.0 months (P = 0.020). The stroke/SE risk was higher in the HFpEF group than in the HFmrEF and HFrEF groups (hazard ratio, 3.192; 95% confidence interval, 1.039–9.810; P = 0.043). E/e' value was an independent risk factor for stroke/SE. There were no significant differences in the incidence of major bleeding across the groups. Conclusions: The stroke/SE risk was the highest in the HFpEF group and comparable between the HFmrEF and HFrEF groups.

Original languageEnglish
Pages (from-to)1582-1589
Number of pages8
JournalESC Heart Failure
Volume8
Issue number2
DOIs
Publication statusPublished - 2021 Apr

Bibliographical note

Funding Information:
This work was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF), which is funded by the Ministry of Science, ICT, and Future Planning (NRF‐2012R1A2A2A02045367, 2010‐0021993), and grants from the Korean Healthcare Technology R&D Project, which is funded by the Ministry of Health and Welfare (HI12C1552, HI16C0058, and HI15C1200).

Publisher Copyright:
© 2021 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

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