Among patients with heart failure (HF) and atrial fibrillation, the risk of stroke and systemic embolism is highest in those with HF with preserved ejection fraction (HFpEF), which is comparable between those with HF with midrange EF (HFmrEF) and those with HF with reduced EF (HFrEF), investigators reported in ESC Heart Failure.
The prospective, multicenter cohort study included 948 age- and sex-matched patients with nonvalvular atrial fibrillation (mean age, 69.0±10.3 years; 69.6% men). Participants were evenly assigned to 1 of 4 HF groups: no-HF, HFpEF, HFmrEF, and HFrEF. The mean follow-up 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 =.043).
The cumulative incidence of stroke and systemic embolism was significantly higher in the HFpEF group compared with the no-HF (P =.025) and HFmrEF (P =.015) groups. No significant differences were observed in the cumulative incidence of stroke and systemic embolism in the HFpEF and HFrEF groups (P =.068). In addition, no significant differences were found in the cumulative incidence of stroke and systemic embolism across the HFmrEF, HFrEF, and no-HF groups.
E/e′ value was an independent risk factor for stroke and systemic embolism, and no significant differences were found in the incidence of major bleeding across the groups.
Among several study limitations, the investigators noted that follow-up echocardiography data were not available, so reversible left ventricular dysfunction was not detected. Also, the follow-up duration was relatively short, and the types of oral anticoagulants that were used were not consistent within the cohort.
“In patients with atrial fibrillation and HF, the risk for stroke/systemic embolism was the highest in association with HFpEF among the 3 HF types,” the researchers commented. “The risk for stroke/systemic embolism was comparable between HFmrEF and HFrEF. Left ventricular diastolic dysfunction may contribute to the risk for stroke/systemic embolism.”
Uhm J-S, Kim J, Yu HT, et al. Stroke and systemic embolism in patients with atrial fibrillation and heart failure according to heart failure type. ESC Heart Fail. Published online February 25, 2021. doi:10.1002/ehf2.13264