Stroke and systemic embolism in patients with atrial fibrillation and heart failure according to heart failure type
- Authors
- Uhm, Jae-Sun; Kim, Jun; Yu, Hee Tae; Kim, Tae-Hoon; Lee, So-Ryoung; Cha, Myung-Jin; Choi, Eue-Keun; Lee, Jung Myung; Kim, Jin-Bae; Park, Junbeom; Park, Jin-Kyu; Kang, Ki-Woon; Shim, Jaemin; Park, Hyung Wook; Lee, Young Soo; Kim, Chang-Soo; Mun, Ji Eun; Son, Nak-Hoon; Joung, Boyoung
- Issue Date
- 4월-2021
- Publisher
- WILEY PERIODICALS, INC
- 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://scholar.korea.ac.kr/handle/2021.sw.korea/137702
- 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 CHA(2)DS(2)-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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