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Heart Failure Subtypes and Thromboembolic Risk in Patients with Atrial Fibrillation: The PREFER in AF - HF substudy
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SYSNO ASEP 0489777 Document Type J - Journal Article R&D Document Type Journal Article Subsidiary J Článek ve WOS Title Heart Failure Subtypes and Thromboembolic Risk in Patients with Atrial Fibrillation: The PREFER in AF - HF substudy Author(s) Siller-Matula, J. M. (AT)
Pecen, Ladislav (UIVT-O) RID, SAI, ORCID
Patti, G. (IT)
Lucerna, M. (DE)
Kirchhof, P. (GB)
Lesiak, M. (PL)
Huber, K. (AT)
Verheugt, F. W. A. (NL)
Lang, I. (AT)
Renda, G. (IT)
Schnabel, R. B. (DE)
Wachter, R. (DE)
Kotecha, D. (GB)
Sellal, J.-M. (FR)
Rohla, M. (AT)
Ricci, F. (IT)
De Caterina, R. (IT)Source Title International Journal of Cardiology. - : Elsevier - ISSN 0167-5273
Roč. 265, August (2018), s. 141-147Number of pages 7 s. Language eng - English Country IE - Ireland Keywords Atrial fibrillation ; Bleeding ; Ejection fraction ; Heart failure ; Stroke Subject RIV FA - Cardiovascular Diseases incl. Cardiotharic Surgery OECD category Cardiac and Cardiovascular systems Institutional support UIVT-O - RVO:67985807 UT WOS 000434679400031 EID SCOPUS 85046126168 DOI 10.1016/j.ijcard.2018.04.093 Annotation BACKGROUND AND OBJECTIVES: To assess thromboembolic and bleeding risks in patients with heart failure (HF) and atrial fibrillation (AF) according to HF type. METHODS: We analyzed 6170 AF patients from the Prevention of thromboembolic events - European Registry in Atrial Fibrillation (PREFER in AF), and categorized patients into: HF with reduced left-ventricular ejection fraction (HFrEF, LVEF < 40%), mid-range EF (HFmrEF, LVEF: 40-49%), lower preserved EF (HFLpEF, LVEF: 50-60%), higher preserved EF (HFHpEF, LVEF > 60%), and no HF. Outcomes were ischemic stroke, major adverse cardiovascular and cerebral events (MACCE) and major bleeding occurring within 1-year. RESULTS: The annual incidence of stroke was linearly and inversely related to LVEF, increasing by 0.054% per each 1% of LVEF decrease (95% CI: 0.013%-0.096%, p = 0.031). Patients with HFHpEF had the highest CHA2DS2-VASc score, but significantly lower stroke incidence than other HF groups (0.65%, compared to HFLpEF 1.30%, HFmrEF 1.71%, HFrEF 1.75%, trend p = 0.014). The incidence of MACCE was also lower in HFHpEF (2.0%) compared to other HF groups (range: 3.8-4.4%, p = 0.001). Age, HF type, and NYHA class were independent predictors of thromboembolic events. Conversely, major bleeding did not significantly differ between groups (p = 0.168). CONCLUSION: Our study in predominantly anticoagulated patients with AF shows that, reduction in LVEF is associated with higher thromboembolic, but not higher bleeding risk. HFHpEF is a distinct and puzzling group, featuring the highest CHA2DS2-VASc score but the lowest residual risk of thromboembolic events, which warrants further investigation. Workplace Institute of Computer Science Contact Tereza Šírová, sirova@cs.cas.cz, Tel.: 266 053 800 Year of Publishing 2019
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