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Stroke and Systemic Embolism and Other Adverse Outcomes of Heart Failure With Preserved and Reduced Ejection Fraction in Patients With Atrial Fibrillation (From the COmparison Study of Drugs for Symptom Control and Complication prEvention of Atrial Fibrillation [CODE-AF])

Authors
 Seyong Chung  ;  Tae-Hoon Kim  ;  Jae-Sun Uhm  ;  Myung-Jin Cha  ;  Jung-Myung Lee  ;  Junbeom Park  ;  Jin-Kyu Park  ;  Ki-Woon Kang  ;  Jun Kim  ;  Hyung Wook Park  ;  Eue-Keun Choi  ;  Jin-Bae Kim  ;  Chang-Soo Kim  ;  Young Soo Lee  ;  Jaemin Shim  ;  Boyoung Joung 
Citation
 AMERICAN JOURNAL OF CARDIOLOGY, Vol.125(1) : 68-75, 2020-01 
Journal Title
 AMERICAN JOURNAL OF CARDIOLOGY 
ISSN
 0002-9149 
Issue Date
2020-01
MeSH
Administration, Oral ; Aged ; Anticoagulants / administration & dosage* ; Atrial Fibrillation / complications* ; Atrial Fibrillation / diagnosis ; Atrial Fibrillation / drug therapy ; Echocardiography ; Embolism / epidemiology ; Embolism / etiology* ; Embolism / prevention & control ; Female ; Follow-Up Studies ; Heart Failure / complications* ; Heart Failure / drug therapy ; Heart Failure / physiopathology ; Heart Ventricles / diagnostic imaging ; Heart Ventricles / physiopathology ; Humans ; Incidence ; Male ; Middle Aged ; Prognosis ; Prospective Studies ; Republic of Korea / epidemiology ; Risk Assessment / methods* ; Risk Factors ; Stroke / epidemiology ; Stroke / etiology* ; Stroke / prevention & control ; Stroke Volume / physiology* ; Survival Rate / trends ; Ventricular Function, Left / physiology
Abstract
It is unknown whether heart failure (HF) with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF) carry a similar risk of stroke or systemic embolism (SE) and other outcomes in patients with nonvalvular atrial fibrillation (AF). A prospective, multicenter outpatient registry with echocardiographic data which enrolled 10,589 patients from June 2016 to May 2019 was analyzed. In this registry, 935 (8.8%) patients had HF, and the proportions of patients with HFpEF and HFrEF were 43.2% and 56.8%, respectively. During follow-up over 1.33 years, 11 (2.07 per 100 person-years [PYR]) and 5 (0.76 per 100 PYR) patients had stroke/SE in the HFpEF and HFrEF groups, respectively, whereas 102 patients (0.84 per 100 PYR) had these sequelae in the no-HF group. The HFpEF group had a significantly higher cumulative incidence of stroke/SE (p = 0.004) and risk of stroke/SE (adjusted hazard ratio [HR] 2.23, 95% confidence interval [CI] 1.19 to 4.18) than the no-HF group. The risk of stroke/SE in the HFpEF group compared with that in the no-HF group was consistently increased even in patients on oral anticoagulation therapy (adjusted HR 2.55, 95% CI 1.31 to 4.96). There was a correlation between larger left atrial size and risk of stroke/SE (adjusted HR 1.53, 95% CI 1.03 to 2.29), but not between reduced left ventricular ejection fraction and this risk. In conclusion, these results suggest that strict oral anticoagulation therapy helps reduce the risk of stroke/SE in patients with nonvalvular AF and HFpEF, especially in those with a larger left atrial size.
Full Text
https://www.sciencedirect.com/science/article/pii/S000291491931104X
DOI
10.1016/j.amjcard.2019.09.035
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Preventive Medicine and Public Health (예방의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Chang Soo(김창수) ORCID logo https://orcid.org/0000-0002-5940-5649
Kim, Tae-Hoon(김태훈) ORCID logo https://orcid.org/0000-0003-4200-3456
Uhm, Jae Sun(엄재선) ORCID logo https://orcid.org/0000-0002-1611-8172
Joung, Bo Young(정보영) ORCID logo https://orcid.org/0000-0001-9036-7225
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/176194
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