Among patients with heart failure (HF) and atrial fibrillation, the risk of stroke and systemic embolism is highest in patients with HF with conserved ejection fraction (HFpEF), which is comparable between patients with HF with medium-range EF (HFmrEF) and patients with HF with reduced EF (HFrEF), the researchers reported ESC heart failure.
The prospective multicenter cohort study comprised 948 age- and gender-adjusted patients with non-valvular atrial fibrillation (mean age 69.0 ± 10.3 years; 69.6% men). The participants were evenly assigned to one of 4 HF groups: no-HF, HFpEF, HFmrEF and HFrEF. The mean follow-up time was 22.8 ± 10.0 months.
The annual incidence of stroke and systemic embolism was 2.8% in the HFpEF group, 0.7% in the HFmrEF group, 1.1% in the HFrEF group, and 0.9% in the no-HF group . The risk of stroke and systemic embolism was higher in the HFpEF group than in the HFmrEF and HFrEF groups (hazard ratio, 3.192; 95% CI, 1.039-9.810; P = 0.043).
The cumulative incidence of stroke and systemic embolism was significantly higher in the HFpEF group than in the group without HF (P = 0.025) and HFmrEF (P = 0.015). No significant differences were observed in the cumulative incidence of stroke and systemic embolism in the HFpEF and HFrEF groups (P = 0.068). Furthermore, no significant differences in the cumulative incidence of stroke and systemic embolism were found between the groups HFmrEF, HFrEF and no-HF.
The E / e ‘value was an independent risk factor for stroke and systemic embolism, and no significant differences in the incidence of major bleeding were found between the groups.
Under several limitations of the study, the researchers found that no follow-up echocardiography data was available so reversible left ventricular dysfunction was not detected. The follow-up period was also relatively short and the oral anticoagulants used were not consistent within the cohort.
“In patients with atrial fibrillation and HF, the risk of stroke / systemic embolism associated with HFpEF was highest among the three HF types,” commented the researchers. “The risk of stroke / systemic embolism was comparable between HFmrEF and HFrEF. Left ventricular diastolic dysfunction can add to the risk of stroke / systemic embolism. “
Uhm JS, Kim J, Yu HT et al. Stroke and systemic embolism in patients with atrial fibrillation and heart failure depending on the type of heart failure. ESC heart failure. Published online on February 25, 2021. doi: 10.1002 / ehf2.13264
This article originally appeared on The Cardiology Advisor