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Impact of heart failure with normal ejection fraction on the occurrence of ischaemic stroke in patients with atrial fibrillation
  1. Sun-Joo Jang1,
  2. Min-Seok Kim1,
  3. Hee-Jung Park1,
  4. Seungbong Han2,
  5. Duk-Hyun Kang1,
  6. Jae-Kwan Song1,
  7. Seong-Wook Park1,
  8. Seung-Jung Park1,
  9. Jae-Joong Kim1
  1. 1Division of Cardiology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
  2. 2Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, Seoul, Korea
  1. Correspondence to Professor Jae-Joong Kim, Division of Cardiology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro 43-Gil, Songpa-gu, Seoul 138-736, Korea; jjkim{at}amc.seoul.kr

Abstract

Objectives The purpose of this study is to examine the risk of stroke in patients with heart failure with normal ejection fraction (HFNEF) and atrial fibrillation (AF).

Design Clinical and echocardiographic data in patients with non-valvular AF who were not on anticoagulation were retrospectively investigated. A total of 304 patients had AF without heart failure, and 102 patients were diagnosed as AF with HFNEF.

Main outcome measures We compared the rate of ischaemic stroke, death and composite of these in the two groups.

Results Patients with AF and HFNEF were older than those with AF only (71.6 vs 64.0 years, p<0.001). Female sex, diabetes mellitus, hypertension, chronic kidney disease, angina, myocardial infarction, use of β blocker or digoxin were more common in patients with AF and HFNEF. The rates of ischaemic stroke, death and composite of ischaemic stroke and death were higher in patients with AF and HFNEF than in those with AF only (20.6% vs 6.7%, p<0.001; 27.2% vs 2.0%, p<0.001; 41.2% vs 8.1%, p<0.001 at 3 years for AF with HFNEF vs AF only, respectively). After adjustment with propensity score method using the inverse probability of treatment weighting, the 3-year risks of for ischaemic stroke (HR 3.29; 95% CI 1.58 to 6.86; p=0.001), death (HR 5.52; 95% CI 2.24 to 13.63; p<0.001), and composite of ischaemic stroke and death (HR 4.08; 95% CI 2.30 to 7.26; p<0.001) were significantly higher in patients with AF and HFNEF.

Conclusions HFNEF is associated with an increased risk of stroke and death in patients with AF.

  • Heart failure with normal ejection fraction
  • stroke
  • heart failure
  • arrhythmias
  • atrial fibrillation
  • peripheral vascular disease
  • cardiac surgery
  • heart transplant

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Footnotes

  • Competing interests None.

  • Ethics approval Ethics approval was provided by Institutional Review Board of Asan Medical Center.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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