0492372 - ÚI 2019 GB eng A - Abstract
Siller-Matula, J. M. - Pecen, Ladislav - Patti, G. - Lucerna, M. - Kirchhof, P. - De Caterina, R.
Heart Failure Subtypes and Thromboembolic Risk in Patients with Atrial Fibrillation in the PREFER in AF Registry.
European Heart Journal. Roč. 38, Suppl. 1 (2017), ehx493.P4900. ISSN 0195-668X. E-ISSN 1522-9645.
[Congress of the European Society of Cardiology 2017. 26.08.2017-30.08.2017, Barcelona]
Keywords : atrial fibrillation * thromboembolism * heart failure
https://esc365.escardio.org/Congress/ESC-CONGRESS-2017/Fresh-look-at-heart-failure/157226-heart-failure-subtypes-and-thromboembolic-risk-in-patients-with-atrial-fibrillation-in-the-prefer-in-af-registry

OBJECTIVE: To assess 1) the incidence of thromboembolic events; and 2) the mortality-weighted net clinical benefit of oral anticoagulation (OAC) according to the heart failure (HF) subtype in patients with atrial fibrillation (AF). METHODS: In this study we included 6,170 patients (1599 with HF and 4751 without HF) with AF from the Prevention of thromboembolic events - European Registry in Atrial Fibrillation (PREFER in AF Registry). We classified patients based on the current ESC HF definitions: HF with reduced ejection fraction (HFrEF; EF<40%); with mid-range EF (HFmrEF; EF: 40–49%); and with preserved ejection fraction (HFpEF; EF≥50%). We then further subdivided patients with HFpEF into HF with lower preserved ejection fraction (HFlpEF; EF: 50–60%) and HF with higher preserved ejection fraction (HFhpEF; EF>60%). We considered as study endpoints ischemic stroke, major adverse cardiovascular and cerebral events (MACCE: stroke, systemic embolism, myocardial infarction and acute coronary syndrome), the composite of thromboembolic events (stroke/TIA/arterial embolism), major bleeding occurring within 1 year of follow-up, and a mortality-weighted net clinical benefit estimate. CONCLUSION: In patients with AF, the subtype of HF predicts the thromboembolic risk: patients with HFhpEF, apparently representing a distinct patient population with the highest CHA2DS2-VASc score, also have the lowest incidence of thromboembolic events. Despite this lowest incidence of thromboembolic events and of MACCE, these patients also feature the highest net clinical benefit, a compounded evaluation of benefit and harm, for OAC. HFrEF is associated with most severe adverse events as ischemic stroke and MACCE.
Permanent Link: http://hdl.handle.net/11104/0285927