Ejection fraction and outcomes in patients with atrial fibrillation and heart failure: the Loire Valley Atrial Fibrillation Project

被引:93
作者
Banerjee, Amitava [1 ]
Taillandier, Sophie [2 ,3 ]
Olesen, Jonas Bjerring [1 ,4 ]
Lane, Deirdre A. [1 ]
Lallemand, Benedicte [2 ,3 ]
Lip, Gregory Y. H. [1 ]
Fauchier, Laurent [2 ,3 ]
机构
[1] Univ Birmingham, Ctr Cardiovasc Sci, City Hosp, Birmingham B18 7QH, W Midlands, England
[2] Ctr Hosp Univ Tours, Serv Cardiol, Univ Trousseau, Tours, France
[3] Univ Tours, Fac Med, Tours, France
[4] Univ Copenhagen, Gentofte Hosp, Dept Cardiol, DK-2900 Hellerup, Denmark
关键词
Heart failure; Atrial fibrillation; Ejection fraction; Stroke; Thrombo-embolism; Risk; CARDIOVASCULAR EVENTS; SYSTOLIC DYSFUNCTION; VENTRICULAR-FUNCTION; RISK STRATIFICATION; PREDICTING STROKE; ISCHEMIC-STROKE; RHYTHM CONTROL; MANAGEMENT; GUIDELINES; MORTALITY;
D O I
10.1093/eurjhf/hfs005
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Heart failure (HF) increases the risk of stroke and thrombo-embolism (TE) in non-valvular atrial fibrillation (NVAF), and is incorporated in stroke risk stratification scores. We aimed to establish the role of ejection fraction (EF) in risk prediction in patients with NVAF and HF. Patients with NVAF, history of HF, and measured EF were included in a retrospective analysis. Patients with HF and preserved ejection fraction (HFPEF) were defined as those with clinical HF and EF epsilon 50 in this study. Among 7156 patients with NVAF, 1276 (17.8) patients with HF and measured EF were included. Of these, 747/1276 (58.5) patients were on vitamin K antagonists. The stroke/TE event rate per 100 person-years was 1.05 [95 confidence interval (CI) 0.871.25]. Patients with HFPEF were more likely to be female (P 0.001), older (P 0.001), and hypertensive (P 0.001), and less likely to have prior vascular disease (P 0.001). There were no differences in rates of stroke (P 0.17) and stroke/TE (P 0.11) between patients with HFPEF and those with HF and reduced EF. There were no significant differences in rates of all-cause mortality when patients were stratified by EF. In multivariate analyses, only previous stroke (hazard ratio 2.36, 95 CI 1.453.86) and vascular disease (1.57, 1.072.30) increased the risk of stroke/TE amongst NVAF patients with HF, but EF 35 did not (0.75, 0.441.30). In NVAF patients with HF, there were no differences in rates of stroke, TE, or death between EF categories. Only previous stroke and vascular disease (and not decreased EF) independently increased risk of stroke/TE in multivariate analyses.
引用
收藏
页码:295 / 301
页数:7
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