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

Jolanta M. Siller-Matula; Ladislav Pecen; Giuseppe Patti; Markus Lucerna; Paulus Kirchhof; Maciej Lesiak; Kurt Huber; Freek W. A. Verheugt; Irene M. Lang; Giulia Renda; Renate B. Schnabel; Rolf Wachter; Dipak Kotecha; Jean-Marc Sellal; Miklos Rohla; Fabrizio Ricci; Raffaele De Caterina; TEAM in AF group

doi:10.1016/j.ijcard.2018.04.093

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

Jolanta M. Siller-Matula, Ladislav Pecen, Giuseppe Patti, Markus Lucerna, Paulus Kirchhof, Maciej Lesiak, Kurt Huber, Freek W. A. Verheugt, Irene M. Lang, Giulia Renda, Renate B. Schnabel, Rolf Wachter, Dipak Kotecha, Jean-Marc Sellal, Miklos Rohla, Fabrizio Ricci, Raffaele De Caterina, TEAM in AF group

Cardiovascular Sciences

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Abstract

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.

Original language	English
Journal	International Journal of Cardiology
Early online date	22 Apr 2018
DOIs	https://doi.org/10.1016/j.ijcard.2018.04.093
Publication status	E-pub ahead of print - 22 Apr 2018

Keywords

atrial fibrillation
heart failure
stroke
ejection fraction
bleeding

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Siller-Matula, J. M., Pecen, L., Patti, G., Lucerna, M., Kirchhof, P., Lesiak, M., Huber, K., Verheugt, F. W. A., Lang, I. M., Renda, G., Schnabel, R. B., Wachter, R., Kotecha, D., Sellal, J.-M., Rohla, M., Ricci, F., De Caterina, R., & TEAM in AF group (2018). Heart failure subtypes and thromboembolic risk in patients with atrial fibrillation: The PREFER in AF - HF substudy. International Journal of Cardiology. Advance online publication. https://doi.org/10.1016/j.ijcard.2018.04.093

@article{3de7b7af28bc460690d8e5acf96e4217,

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

abstract = "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.",

keywords = "atrial fibrillation , heart failure , stroke , ejection fraction , bleeding",

author = "Siller-Matula, {Jolanta M.} and Ladislav Pecen and Giuseppe Patti and Markus Lucerna and Paulus Kirchhof and Maciej Lesiak and Kurt Huber and Verheugt, {Freek W. A.} and Lang, {Irene M.} and Giulia Renda and Schnabel, {Renate B.} and Rolf Wachter and Dipak Kotecha and Jean-Marc Sellal and Miklos Rohla and Fabrizio Ricci and {De Caterina}, Raffaele and {TEAM in AF group}",

year = "2018",

month = apr,

day = "22",

doi = "10.1016/j.ijcard.2018.04.093",

language = "English",

journal = "International Journal of Cardiology",

issn = "0167-5273",

publisher = "Elsevier",

}

Siller-Matula, JM, Pecen, L, Patti, G, Lucerna, M, Kirchhof, P, Lesiak, M, Huber, K, Verheugt, FWA, Lang, IM, Renda, G, Schnabel, RB, Wachter, R, Kotecha, D, Sellal, J-M, Rohla, M, Ricci, F, De Caterina, R & TEAM in AF group 2018, 'Heart failure subtypes and thromboembolic risk in patients with atrial fibrillation: The PREFER in AF - HF substudy', International Journal of Cardiology. https://doi.org/10.1016/j.ijcard.2018.04.093

TY - JOUR

T1 - Heart failure subtypes and thromboembolic risk in patients with atrial fibrillation:

T2 - The PREFER in AF - HF substudy

AU - Siller-Matula, Jolanta M.

AU - Pecen, Ladislav

AU - Patti, Giuseppe

AU - Lucerna, Markus

AU - Kirchhof, Paulus

AU - Lesiak, Maciej

AU - Huber, Kurt

AU - Verheugt, Freek W. A.

AU - Lang, Irene M.

AU - Renda, Giulia

AU - Schnabel, Renate B.

AU - Wachter, Rolf

AU - Kotecha, Dipak

AU - Sellal, Jean-Marc

AU - Rohla, Miklos

AU - Ricci, Fabrizio

AU - De Caterina, Raffaele

AU - TEAM in AF group

PY - 2018/4/22

Y1 - 2018/4/22

N2 - 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.

AB - 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.

KW - atrial fibrillation

KW - heart failure

KW - stroke

KW - ejection fraction

KW - bleeding

U2 - 10.1016/j.ijcard.2018.04.093

DO - 10.1016/j.ijcard.2018.04.093

M3 - Article

C2 - 29706429

SN - 0167-5273

JO - International Journal of Cardiology

JF - International Journal of Cardiology

ER -

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

Abstract

Keywords

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