TY - JOUR
T1 - Thromboembolisms in atrial fibrillation and heart failure patients with a preserved ejection fraction (HFpEF) compared to those with a reduced ejection fraction (HFrEF)
AU - Sobue, Yoshihiro
AU - Watanabe, Eiichi
AU - Lip, Gregory Y.H.
AU - Koshikawa, Masayuki
AU - Ichikawa, Tomohide
AU - Kawai, Mayumi
AU - Harada, Masahide
AU - Inamasu, Joji
AU - Ozaki, Yukio
N1 - Funding Information:
Funding EW is supported by a Grant from the Suzuken Memorial Foundation and JSPS KAKENHI Grant No. 26461094.
Funding Information:
We thank Yuki Shiino and Shiho Ishikawa for the support with the data collection. EW is supported by a Grant from the Suzuken Memorial Foundation and JSPS KAKENHI Grant No. 26461094. Dr. Watanabe: lecture fees from Daiichi-Sankyo, research fund from Boehringer Ingelheim, Takeda Pharmaceutical Company, Japan Lifeline, Medtronic Japan, Boston Scientific Japan, Biotronik Japan, and St. Jude Medical Japan. Dr. Lip: Chairman, Scientific Documents Committee, European Heart Rhythm Association (EHRA); reviewer for various guidelines and position statements from the ESC, EHRA, NICE, etc.; Steering Committees/trials: includes steering committees for various Phase II and III studies, Health Economics & Outcomes Research, etc.; investigator for various clinical trials in cardiovascular disease, including those on antithrombotic therapies in atrial fibrillation, acute coronary syndrome, lipids, etc.; consultant for Bayer/Janssen, Astellas, Merck, Sanofi, BMS/Pfizer, Biotronik, Medtronic, Portola, Boehringer Ingelheim, Microlife and Daiichi-Sankyo. Speaker for Bayer, BMS/Pfizer, Medtronic, Boehringer Ingelheim, Microlife, Roche and Daiichi-Sankyo.
Publisher Copyright:
© 2017, Springer Japan KK.
PY - 2018/4/1
Y1 - 2018/4/1
N2 - Heart failure (HF) is classified into three clinical subtypes: HF with a preserved ejection fraction (HFpEF: EF ≥ 50%), HF with a mid-range ejection fraction (HFmrEF: 40 ≤ EF < 49%), and HF with a reduced ejection fraction (HFrEF: EF < 40%). These types often coexist with atrial fibrillation (AF). We investigated the rate of strokes/systemic embolisms (SSEs) in AF patients with HFpEF (AF-HFpEF) compared to that in those with HFrEF (AF-HFrEF: HFmrEF and HFrEF), and examined the independent predictors. We prospectively enrolled 1350 patients admitted to our hospital for worsening HF. We identified 301 patients with either AF-HFpEF (n = 129, 43%) or AF-HFrEF (n = 172, 57%). Compared to the patients with AF-HFrEF, those with AF-HFpEF were older and more likely to be female. Oral anticoagulant use was 63 vs. 66%, respectively. During a mean follow-up period of 26 months, 21 (7%) and 66 (22%) patients had SSEs and all-cause death, respectively. The crude annual rates of SSEs (3.9 vs. 2.7%, P = 0.47) were similar between the groups. In a multivariate Cox regression analysis, an age ≥ 75 years (hazard ratio 2.14, 95% confidence interval 1.32–3.58, P < 0.01) and the plasma B-type natriuretic peptide (BNP) level ≥ 341 pg/ml (hazard ratio 1.60, 95% confidence interval 1.07–2.39, P < 0.05) were associated with SSEs. The EF was not an independent predictor of SSEs (hazard ratio 1.01, 95% confidence interval 0.98–1.04, P = 0.51). There were no significant differences in the rates of SSEs between AF-HFpEF and AF-HFrEF. Patients with HF and concomitant AF should be treated with anticoagulants irrespective of EF.
AB - Heart failure (HF) is classified into three clinical subtypes: HF with a preserved ejection fraction (HFpEF: EF ≥ 50%), HF with a mid-range ejection fraction (HFmrEF: 40 ≤ EF < 49%), and HF with a reduced ejection fraction (HFrEF: EF < 40%). These types often coexist with atrial fibrillation (AF). We investigated the rate of strokes/systemic embolisms (SSEs) in AF patients with HFpEF (AF-HFpEF) compared to that in those with HFrEF (AF-HFrEF: HFmrEF and HFrEF), and examined the independent predictors. We prospectively enrolled 1350 patients admitted to our hospital for worsening HF. We identified 301 patients with either AF-HFpEF (n = 129, 43%) or AF-HFrEF (n = 172, 57%). Compared to the patients with AF-HFrEF, those with AF-HFpEF were older and more likely to be female. Oral anticoagulant use was 63 vs. 66%, respectively. During a mean follow-up period of 26 months, 21 (7%) and 66 (22%) patients had SSEs and all-cause death, respectively. The crude annual rates of SSEs (3.9 vs. 2.7%, P = 0.47) were similar between the groups. In a multivariate Cox regression analysis, an age ≥ 75 years (hazard ratio 2.14, 95% confidence interval 1.32–3.58, P < 0.01) and the plasma B-type natriuretic peptide (BNP) level ≥ 341 pg/ml (hazard ratio 1.60, 95% confidence interval 1.07–2.39, P < 0.05) were associated with SSEs. The EF was not an independent predictor of SSEs (hazard ratio 1.01, 95% confidence interval 0.98–1.04, P = 0.51). There were no significant differences in the rates of SSEs between AF-HFpEF and AF-HFrEF. Patients with HF and concomitant AF should be treated with anticoagulants irrespective of EF.
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U2 - 10.1007/s00380-017-1073-5
DO - 10.1007/s00380-017-1073-5
M3 - Article
C2 - 29067492
AN - SCOPUS:85032006205
VL - 33
SP - 403
EP - 412
JO - Heart and Vessels
JF - Heart and Vessels
SN - 0910-8327
IS - 4
ER -