The Risk of Ischemic Stroke Following Hospitalization for Acute Heart Failure Among Patients with Atrial Fibrillation

Background – Heart failure (HF) patients with atrial fibrillation (AF) are at increased risk of ischemic stroke. However, there are limited data on the risk of stroke following hospitalization with acute HF among patients with preserved ejection fraction (HFpEF) vs. reduced ejection fraction (HFrEF) who receive oral anticoagulation (OAC).

Methods – The study population comprised 3,797 patients hospitalized at the Sheba Medical Center with the diagnosis of acute decompensated HF between 2008-2017. All patients had AF and where treated with anti-coagulation based on CHADSVASC or their physician’s discretion. Subjects were divided into two groups based on their echocardiography findings: HFpEF (N=3,055) and HFrEF (N=742). The primary end point was ischemic stroke at 1 year.

Results – Mean age of the study population was 79±11 years with nearly 1:1 male to female ratio. Mean CHADSVASC score was 4.4±1.7 and 4.9±1.6 for the HFrEF and HFpEF groups, respectively. Kaplan Meier’s survival analysis demonstrated that at 1-year of follow-up the rate of stroke was very high (8%) and virtually identical between the two EF groups (figure). Consistently, multivariate Cox proportional-hazards regression analysis, adjusted for anti-coagulation treatment and CHADSVASC score, showed that the risk of stroke was not significantly different between the HFrEF vs. the HFpEF groups (HR=0.85, 95% CI 0.66-1.09, p=0.19).

Conclusions – The rate of ischemic stroke in AF patients at 1-year following acute decompensated HF hospitalization is very high (8%) despite treatment with OAC, with a similar event rate among both HFpEF and HFrEF patients.