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Heart failure subtypes and thromboembolic risk in patients with atrial fibrillation: The PREFER in AF - HF substudy

JM. Siller-Matula, L. Pecen, G. Patti, M. Lucerna, P. Kirchhof, M. Lesiak, K. Huber, FWA. Verheugt, IM. Lang, G. Renda, RB. Schnabel, R. Wachter, D. Kotecha, JM. Sellal, M. Rohla, F. Ricci, R. De Caterina, . ,

. 2018 ; 265 (-) : 141-147. [pub] 20180422

Language English Country Netherlands

Document type Journal Article

Persistent link   https://www.medvik.cz/link/bmc19012697

BACKGROUND AND OBJECTIVES: To assess thromboembolic and bleeding risks in patients with heart failure (HF) and atrial fibrillation (AF) according to HF type. METHODS: We analyzed 6170 AF patients from the Prevention of thromboembolic events - European Registry in Atrial Fibrillation (PREFER in AF), and categorized patients into: HF with reduced left-ventricular ejection fraction (HFrEF; LVEF < 40%); mid-range EF (HFmrEF; LVEF: 40-49%); lower preserved EF (HFLpEF; LVEF: 50-60%), higher preserved EF (HFHpEF; LVEF > 60%), and no HF. Outcomes were ischemic stroke, major adverse cardiovascular and cerebral events (MACCE) and major bleeding occurring within 1-year. RESULTS: The annual incidence of stroke was linearly and inversely related to LVEF, increasing by 0.054% per each 1% of LVEF decrease (95% CI: 0.013%-0.096%; p = 0.031). Patients with HFHpEF had the highest CHA2DS2-VASc score, but significantly lower stroke incidence than other HF groups (0.65%, compared to HFLpEF 1.30%; HFmrEF 1.71%; HFrEF 1.75%; trend p = 0.014). The incidence of MACCE was also lower in HFHpEF (2.0%) compared to other HF groups (range: 3.8-4.4%; p = 0.001). Age, HF type, and NYHA class were independent predictors of thromboembolic events. Conversely, major bleeding did not significantly differ between groups (p = 0.168). CONCLUSION: Our study in predominantly anticoagulated patients with AF shows that, reduction in LVEF is associated with higher thromboembolic, but not higher bleeding risk. HFHpEF is a distinct and puzzling group, featuring the highest CHA2DS2-VASc score but the lowest residual risk of thromboembolic events, which warrants further investigation.

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$a Siller-Matula, Jolanta M $u Department of Cardiology, Medical University of Vienna, Vienna, Austria; 1st Department of Cardiology, Poznan University of Medical Sciences, Poland. Electronic address: jolanta.siller-matula@meduniwien.ac.at.
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$a Heart failure subtypes and thromboembolic risk in patients with atrial fibrillation: The PREFER in AF - HF substudy / $c JM. Siller-Matula, L. Pecen, G. Patti, M. Lucerna, P. Kirchhof, M. Lesiak, K. Huber, FWA. Verheugt, IM. Lang, G. Renda, RB. Schnabel, R. Wachter, D. Kotecha, JM. Sellal, M. Rohla, F. Ricci, R. De Caterina, . ,
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$a BACKGROUND AND OBJECTIVES: To assess thromboembolic and bleeding risks in patients with heart failure (HF) and atrial fibrillation (AF) according to HF type. METHODS: We analyzed 6170 AF patients from the Prevention of thromboembolic events - European Registry in Atrial Fibrillation (PREFER in AF), and categorized patients into: HF with reduced left-ventricular ejection fraction (HFrEF; LVEF < 40%); mid-range EF (HFmrEF; LVEF: 40-49%); lower preserved EF (HFLpEF; LVEF: 50-60%), higher preserved EF (HFHpEF; LVEF > 60%), and no HF. Outcomes were ischemic stroke, major adverse cardiovascular and cerebral events (MACCE) and major bleeding occurring within 1-year. RESULTS: The annual incidence of stroke was linearly and inversely related to LVEF, increasing by 0.054% per each 1% of LVEF decrease (95% CI: 0.013%-0.096%; p = 0.031). Patients with HFHpEF had the highest CHA2DS2-VASc score, but significantly lower stroke incidence than other HF groups (0.65%, compared to HFLpEF 1.30%; HFmrEF 1.71%; HFrEF 1.75%; trend p = 0.014). The incidence of MACCE was also lower in HFHpEF (2.0%) compared to other HF groups (range: 3.8-4.4%; p = 0.001). Age, HF type, and NYHA class were independent predictors of thromboembolic events. Conversely, major bleeding did not significantly differ between groups (p = 0.168). CONCLUSION: Our study in predominantly anticoagulated patients with AF shows that, reduction in LVEF is associated with higher thromboembolic, but not higher bleeding risk. HFHpEF is a distinct and puzzling group, featuring the highest CHA2DS2-VASc score but the lowest residual risk of thromboembolic events, which warrants further investigation.
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$a Pecen, Ladislav $u Institute of Informatics, Academy of Sciences of Czech Republic, Prague, Czech Republic.
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$a Patti, Giuseppe $u Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Italy.
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$a Lucerna, Markus $u Daiichi Sankyo Europe, Munich, Germany.
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$a Kirchhof, Paulus $u Institute of Cardiovascular Sciences, University of Birmingham and SWBH and UHB NHS Trusts, Birmingham, UK; AFNET, Münster, Germany.
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$a Lesiak, Maciej $u 1st Department of Cardiology, Poznan University of Medical Sciences, Poland.
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$a Huber, Kurt $u 3rd Medical Department, Cardiology and Intensive Care Medicine, Wilhelminen Hospital, and Sigmund Freud University, Medical School, Vienna, Austria.
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$a Verheugt, Freek W A $u Emeritus Professor of Cardiology, Amsterdam, The Netherlands.
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$a Lang, Irene M $u Department of Cardiology, Medical University of Vienna, Vienna, Austria.
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$a Renda, Giulia $u G. d'Annunzio University of Chieti and Center of Excellence on Aging, CeSI-Met, Italy.
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$a Schnabel, Renate B $u Department for General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany; German Center for Cardiovascular Research (DZHK) partner site Hamburg/Kiel/Lübeck, Hamburg, Germany.
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$a Wachter, Rolf $u Clinic for Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany; German Center for Cardiovascular Research, partner site, Göttingen, Germany.
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$a Kotecha, Dipak $u Institute of Cardiovascular Sciences, University of Birmingham and SWBH and UHB NHS Trusts, Birmingham, UK.
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$a Sellal, Jean-Marc $u Department of Cardiology, University Hospital Nancy, France.
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$a Rohla, Miklos $u 3rd Medical Department, Cardiology and Intensive Care Medicine, Wilhelminen Hospital, Vienna, Austria.
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$a Ricci, Fabrizio $u G. d'Annunzio University of Chieti and Center of Excellence on Aging, CeSI-Met, Italy.
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$a De Caterina, Raffaele $u G. d'Annunzio University of Chieti and Center of Excellence on Aging, CeSI-Met, Italy. Electronic address: rdecater@unich.it.
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