History of Atrial Fibrillation as a Risk Factor in Patients With Heart Failure and Preserved Ejection Fraction.
Circ Heart Fail. 2014 Sep 15;
Authors: Oluleye OW, Rector TS, Win S, McMurray JJ, Zile M, Komajda M, McKelvie RS, Massie B, Carson PE, Anand IS
BACKGROUND: -Atrial fibrillation (AFib) is common in heart failure (HF) with preserved ejection fraction (HFpEF). Current AFib stroke risk prediction models include the presence of HF but do not specifically include HFpEF as a risk factor. Whether a history of AFib should be used to identify patients with HFpEF who are at risk has not been established.
METHODS AND RESULTS: -Baseline characteristics and outcomes of patients with HFpEF in the I-PRESERVE Trial were analyzed in relation to AFib. At baseline, 1,209 (29.3%) had a history of AFib. Of these 557 (13.5%) had history of AFib alone, whereas 670 (16.2%) had both a history and AFib on ECG; 2,901 (70.3%) had neither. There were no significant differences in the risk of stroke between the two groups with a history of AFib who did or did not have AFib present on baseline ECG. During a median follow-up of 53 months, a fatal or non-fatal stroke occurred in 6.5% (79/1,209) patients with history of AFib compared to 3.9% (114/2,901) with no AFib. Having a history of AFib was independently associated with higher risk of stroke (hazard ratio 2.2; 95% CI 1.6-3.2; p<0.0001) compared to those with no history of AFib.
CONCLUSIONS: -In patients with HFpEF, a history of AFib was common and independently associated with increased risk of stroke, regardless of whether AFib was present on ECG. Patients with HFpEF and a history of AFib should be considered at risk. Further studies are needed to determine whether this risk can be safely reduced.
CLINICAL TRIAL REGISTRATION: -URL: http://www.clinicaltrials.gov. Unique identifier: NCT000095238.
PMID: 25225241 [PubMed - as supplied by publisher]