Abstract
Heart failure (HF) is classified into three clinical subtypes: HF with a preserved ejection fraction (HFpEF: EF ≥ 50%), HF with a mid-range ejection fraction (HFmrEF: 40 ≤ EF < 49%), and HF with a reduced ejection fraction (HFrEF: EF < 40%). These types often coexist with atrial fibrillation (AF). We investigated the rate of strokes/systemic embolisms (SSEs) in AF patients with HFpEF (AF-HFpEF) compared to that in those with HFrEF (AF-HFrEF: HFmrEF and HFrEF), and examined the independent predictors. We prospectively enrolled 1350 patients admitted to our hospital for worsening HF. We identified 301 patients with either AF-HFpEF (n = 129, 43%) or AF-HFrEF (n = 172, 57%). Compared to the patients with AF-HFrEF, those with AF-HFpEF were older and more likely to be female. Oral anticoagulant use was 63 vs. 66%, respectively. During a mean follow-up period of 26 months, 21 (7%) and 66 (22%) patients had SSEs and all-cause death, respectively. The crude annual rates of SSEs (3.9 vs. 2.7%, P = 0.47) were similar between the groups. In a multivariate Cox regression analysis, an age ≥ 75 years (hazard ratio 2.14, 95% confidence interval 1.32–3.58, P < 0.01) and the plasma B-type natriuretic peptide (BNP) level ≥ 341 pg/ml (hazard ratio 1.60, 95% confidence interval 1.07–2.39, P < 0.05) were associated with SSEs. The EF was not an independent predictor of SSEs (hazard ratio 1.01, 95% confidence interval 0.98–1.04, P = 0.51). There were no significant differences in the rates of SSEs between AF-HFpEF and AF-HFrEF. Patients with HF and concomitant AF should be treated with anticoagulants irrespective of EF.
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Acknowledgements
We thank Yuki Shiino and Shiho Ishikawa for the support with the data collection.
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EW is supported by a Grant from the Suzuken Memorial Foundation and JSPS KAKENHI Grant No. 26461094.
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Dr. Watanabe: lecture fees from Daiichi-Sankyo, research fund from Boehringer Ingelheim, Takeda Pharmaceutical Company, Japan Lifeline, Medtronic Japan, Boston Scientific Japan, Biotronik Japan, and St. Jude Medical Japan. Dr. Lip: Chairman, Scientific Documents Committee, European Heart Rhythm Association (EHRA); reviewer for various guidelines and position statements from the ESC, EHRA, NICE, etc.; Steering Committees/trials: includes steering committees for various Phase II and III studies, Health Economics & Outcomes Research, etc.; investigator for various clinical trials in cardiovascular disease, including those on antithrombotic therapies in atrial fibrillation, acute coronary syndrome, lipids, etc.; consultant for Bayer/Janssen, Astellas, Merck, Sanofi, BMS/Pfizer, Biotronik, Medtronic, Portola, Boehringer Ingelheim, Microlife and Daiichi-Sankyo. Speaker for Bayer, BMS/Pfizer, Medtronic, Boehringer Ingelheim, Microlife, Roche and Daiichi-Sankyo.
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Sobue, Y., Watanabe, E., Lip, G.Y.H. et al. Thromboembolisms in atrial fibrillation and heart failure patients with a preserved ejection fraction (HFpEF) compared to those with a reduced ejection fraction (HFrEF). Heart Vessels 33, 403–412 (2018). https://doi.org/10.1007/s00380-017-1073-5
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DOI: https://doi.org/10.1007/s00380-017-1073-5