Both HFpEF and HFmrEF should be included in calculating CHADS-VASc score: A Taiwanese longitudinal cohort.
Journal
Heart rhythm
Journal Volume
21
Journal Issue
9
Pages
1500 - 1506
ISSN
1556-3871
Date Issued
2024-02-27
Author(s)
Cheng, Chien-Chien
Chen, Jien-Jiun
Chiu, Fu-Chun
Abstract
Congestive heart failure (CHF) as a risk of stroke in patients with atrial fibrillation (AF) mainly referred to patients with left ventricular systolic dysfunction. Whether this should include patients with preserved ejection fraction is debatable.
The study aimed to investigate the variation in stroke risk of AF patients with heart failure with preserved ejection fraction (HFpEF), heart failure with mid-range ejection fraction (HFmrEF), and heart failure with reduced ejection fraction (HFrEF) for enhancing risk assessment and subsequent management strategies.
In a longitudinal study using the National Taiwan University Hospital integrated Medical Database, 8358 patients with AF were observed for 10 years (mean follow-up, 3.76 years). The study evaluated the risk of ischemic stroke in patients with differing ejection fractions and CHADS-VASc score, further using Cox models adjusted for risk factors of AF-related stroke.
Patients with HFpEF and HFmrEF had a higher mean CHADS-VASc score compared with patients with HFrEF (4.30 ± 1.729 vs 4.15 ± 1.736 vs 3.73 ± 1.712; P < .001) and higher risk of stroke during follow-up (hazard ratio [HR], 1.40 [1.161-1.688; P < .001] for HFmrEF; HR, 1.184 [1.075-1.303; P = .001] for HFpEF vs no CHF) after multivariate adjustment). In patients with lower CHADS-VASc score (0-4), presence of any type of CHF increased ischemic stroke risk (HFrEF HR, 1.568 [1.189-2.068; P = .001]; HFmrEF HR, 1.890 [1.372-2.603; P < .001]; HFpEF HR, 1.800 [1.526-2.123; P < .001] vs no CHF).
After multivariate adjustment, HFpEF and HFmrEF showed a similar risk of stroke in AF patients. Therefore, it is important to extend the criteria for C in the CHADS-VASc score to include patients with HFpEF and HFmrEF. In patients with fewer concomitant stroke risk factors, the presence of any subtype of CHF increases risk for ischemic stroke.
Subjects
Atrial fibrillation
CHA(2)DS(2)-VASc score
HFmrEF
HFpEF
HFrEF
Ischemic stroke
Type
journal article