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

Authors
Uhm, Jae-SunKim, JunYu, Hee TaeKim, Tae-HoonLee, So-RyoungCha, Myung-JinChoi, Eue-KeunLee, Jung MyungKim, Jin-BaePark, JunbeomPark, Jin KyuKang, Ki-WoonShim, JaeminPark, Hyung WookLee, Young SooKim, Chang-SooMun, Ji EunSon, Nak-HoonJoung, Boyoung
Issue Date
Apr-2021
Publisher
Heart Failure Association of the European Society of Cardiology | Wiley
Keywords
Atrial fibrillation; Bleeding; Ejection fraction; Heart failure; Stroke; Systemic embolism
Citation
ESC Heart Failure, v.8, no.2, pp.1582 - 1589
Indexed
SCIE
SCOPUS
Journal Title
ESC Heart Failure
Volume
8
Number
2
Start Page
1582
End Page
1589
URI
https://scholarworks.bwise.kr/hanyang/handle/2021.sw.hanyang/7955
DOI
10.1002/ehf2.13264
ISSN
2055-5822
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.
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