The impact of heart failure and left ventricular dysfunction in predicting stroke, thromboembolism, and mortality in atrial fibrillation patients: a systematic review

Megha Agarwal, Stavros Apostolakis, Deirdre A Lane, Gregory Y H Lip

Research output: Contribution to journalArticlepeer-review

43 Citations (Scopus)

Abstract

PURPOSE: Atrial fibrillation (AF) is commonly associated with structural heart disease. Although heart failure (HF) has been proposed as a risk factor for stroke, the coexistence of the 2 diseases increases disproportionally the risk of thromboembolic events. Our objective was to conduct a systematic review to assess the effect of HF on the end points of stroke, systemic embolism (SE), or mortality in patients with AF.

METHODS: A literature search was performed to identify studies that examined stroke/ SE in relation to AF and HF. Overall, 405 articles satisfied the preinclusion criteria.

FINDINGS: In studies in which HF was based on a clinical diagnosis, HF independently increased stroke/SE in 5 of 13 studies, conferring 1.6- to 3.1-fold increase in risk. When HF was defined as impaired left ventricular (LV) function on echocardiography, the additive risk was evident in 4 of 6 studies, with 1.7- to 2.6-fold increase in the risk of stroke/SE. The data about HF with preserved ejection fraction were less robust, although a recent presentation with acute decompensated HF increased the risk of stroke/SE, irrespective of ejection fraction.

IMPLICATIONS: LV systolic impairment as identified by echocardiography is an independent risk factor for stroke/SE, although the magnitude by which it increases the risk of stroke cannot be precisely quantified. Whether a clinical diagnosis of HF is a significant risk factor remains inconclusive, although when the diagnosis is certain (recent decompensation requiring hospitalization), it does seem to be a significant risk factor irrespective of LV systolic function.

Original languageEnglish
Pages (from-to)1135-1144
Number of pages10
JournalClinical Therapeutics
Volume36
Issue number9
Early online date19 Aug 2014
DOIs
Publication statusPublished - 1 Sep 2014

Keywords

  • atrial fibrillation
  • cardiac failure
  • thromboembolism
  • stroke
  • risk factors

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