Heart Failure Reviews

, Volume 19, Issue 3, pp 305–313 | Cite as

Atrial fibrillation in heart failure: stroke risk stratification and anticoagulation



For an individual patient with both atrial fibrillation and heart failure, stroke risk is one of the most prominent mitigating factors for subsequent morbidity and mortality. Although the CHADS2 stroke risk score is the most widely used score for risk stratification, it does not take into account the risk factors of vascular disease, female gender, or the age group 65–74 years, for which there is increasing evidence. There is also evidence that diastolic heart failure is as much a risk factor for stroke as systolic heart failure. The new oral anticoagulants dabigatran, rivaroxaban and apixaban appear to be appropriate agents in the heart failure population with atrial fibrillation and risk factors for stroke although there are dose-adjustments for renal insufficiency and these medications are contraindicated in advanced renal disease. As with the atrial fibrillation population as a whole, bleeding risk should be considered for every patient with heart failure prior to making recommendations regarding anticoagulation.


Heart failure Atrial fibrillation Stroke Anticoagulation 


Conflict of interest

JoEllyn M. Abraham: None. Stuart J. Connolly: Honoraria for lectures and consulting for Boehringer Ingelheim, Bristol-Myers Squibb, Pfizer, Sanofi Aventis, Portola, Bayer and Johnson and Johnson.


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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Department of Cardiovascular MedicineCleveland ClinicClevelandUSA
  2. 2.Division of CardiologyMcMaster UniversityHamiltonCanada

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