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Heart failure: a weak link in CHA(2)DS(2)‐VASc
AIMS: In atrial fibrillation, stroke risk is assessed by the CHA(2)DS(2)‐VASc score. Heart failure is included in CHA(2)DS(2)‐VASc, but the rationale is uncertain. Our objective was to test if heart failure is a risk factor for stroke, independent of other risk factors in CHA(2)DS(2)‐VASc. METHODS A...
Autores principales: | , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5933948/ https://www.ncbi.nlm.nih.gov/pubmed/29446254 http://dx.doi.org/10.1002/ehf2.12262 |
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author | Friberg, Leif Lund, Lars H. |
author_facet | Friberg, Leif Lund, Lars H. |
author_sort | Friberg, Leif |
collection | PubMed |
description | AIMS: In atrial fibrillation, stroke risk is assessed by the CHA(2)DS(2)‐VASc score. Heart failure is included in CHA(2)DS(2)‐VASc, but the rationale is uncertain. Our objective was to test if heart failure is a risk factor for stroke, independent of other risk factors in CHA(2)DS(2)‐VASc. METHODS AND RESULTS: We studied 300 839 patients with atrial fibrillation in the Swedish Patient Register 2005–11. Three definitions of heart failure were used in order to assess the robustness of the results. In the main analysis, heart failure was defined by a hospital discharge diagnosis of heart failure as first or second diagnosis and a filled prescription of a diuretic within 3 months before index + 30 days. The second definition counted first or second discharge diagnoses <1 year before index + 30 days and the third definition any heart failure diagnosis in open or hospital care before index + 30 days. Associations with outcomes were assessed with multivariable Cox analyses. Patients with heart failure were older (80.5 vs. 74.0 years, P < 0.001) and had higher CHA(2)DS(2)‐VASc score (4.4 vs. 2.7, P < 0.001). The 1 year incidence of ischaemic stroke without warfarin was 4.4% with heart failure and 3.1% without. Adjustment for the cofactors in CHA(2)DS(2)‐VASc eradicated the difference in stroke risk between patients with and without heart failure (hazard ratio 1.01 with 95% confidence interval 0.96–1.05). The area under the receiver operating characteristic curve for CHA(2)DS(2)‐VASc was not improved by points for heart failure. CONCLUSIONS: A clinical diagnosis of heart failure was not an independent risk factor for stroke in patients with atrial fibrillation, which may have implications for anticoagulation management. |
format | Online Article Text |
id | pubmed-5933948 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-59339482018-05-10 Heart failure: a weak link in CHA(2)DS(2)‐VASc Friberg, Leif Lund, Lars H. ESC Heart Fail Original Research Articles AIMS: In atrial fibrillation, stroke risk is assessed by the CHA(2)DS(2)‐VASc score. Heart failure is included in CHA(2)DS(2)‐VASc, but the rationale is uncertain. Our objective was to test if heart failure is a risk factor for stroke, independent of other risk factors in CHA(2)DS(2)‐VASc. METHODS AND RESULTS: We studied 300 839 patients with atrial fibrillation in the Swedish Patient Register 2005–11. Three definitions of heart failure were used in order to assess the robustness of the results. In the main analysis, heart failure was defined by a hospital discharge diagnosis of heart failure as first or second diagnosis and a filled prescription of a diuretic within 3 months before index + 30 days. The second definition counted first or second discharge diagnoses <1 year before index + 30 days and the third definition any heart failure diagnosis in open or hospital care before index + 30 days. Associations with outcomes were assessed with multivariable Cox analyses. Patients with heart failure were older (80.5 vs. 74.0 years, P < 0.001) and had higher CHA(2)DS(2)‐VASc score (4.4 vs. 2.7, P < 0.001). The 1 year incidence of ischaemic stroke without warfarin was 4.4% with heart failure and 3.1% without. Adjustment for the cofactors in CHA(2)DS(2)‐VASc eradicated the difference in stroke risk between patients with and without heart failure (hazard ratio 1.01 with 95% confidence interval 0.96–1.05). The area under the receiver operating characteristic curve for CHA(2)DS(2)‐VASc was not improved by points for heart failure. CONCLUSIONS: A clinical diagnosis of heart failure was not an independent risk factor for stroke in patients with atrial fibrillation, which may have implications for anticoagulation management. John Wiley and Sons Inc. 2018-02-15 /pmc/articles/PMC5933948/ /pubmed/29446254 http://dx.doi.org/10.1002/ehf2.12262 Text en © 2018 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology. This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made. |
spellingShingle | Original Research Articles Friberg, Leif Lund, Lars H. Heart failure: a weak link in CHA(2)DS(2)‐VASc |
title | Heart failure: a weak link in CHA(2)DS(2)‐VASc |
title_full | Heart failure: a weak link in CHA(2)DS(2)‐VASc |
title_fullStr | Heart failure: a weak link in CHA(2)DS(2)‐VASc |
title_full_unstemmed | Heart failure: a weak link in CHA(2)DS(2)‐VASc |
title_short | Heart failure: a weak link in CHA(2)DS(2)‐VASc |
title_sort | heart failure: a weak link in cha(2)ds(2)‐vasc |
topic | Original Research Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5933948/ https://www.ncbi.nlm.nih.gov/pubmed/29446254 http://dx.doi.org/10.1002/ehf2.12262 |
work_keys_str_mv | AT fribergleif heartfailureaweaklinkincha2ds2vasc AT lundlarsh heartfailureaweaklinkincha2ds2vasc |