1. The Impact of Heart Failure and Left Ventricular Dysfunction in Predicting Stroke, Thromboembolism, and Mortality in Atrial Fibrillation Patients: A Systematic Review.
- Author
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Agarwal, Megha, Apostolakis, Stavros, Lane, Deirdre A., and Lip, Gregory Y. H.
- Subjects
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THROMBOEMBOLISM risk factors , *HEART failure risk factors , *HEART ventricle diseases , *ATRIAL fibrillation , *CONFIDENCE intervals , *LEFT heart ventricle , *MEDLINE , *META-analysis , *MORTALITY , *ONLINE information services , *RESEARCH funding , *SYSTEMATIC reviews , *DISEASE complications ,STROKE risk factors - Abstract
Purpose: Atrial fibrillation (AF) is commonly associated with structural heart disease. Although heart failure (HF) has been proposed as a risk factor for stroke, the coexistence of the 2 diseases increases disproportionally the risk of thromboembolic events. Our objective was to conduct a systematic review to assess the effect of HF on the end points of stroke, systemic embolism (SE), or mortality in patients with AF. Methods: A literature search was performed to identify studies that examined stroke/ SE in relation to AF and HF. Overall, 405 articles satisfied the preinclusion criteria. Findings: In studies in which HF was based on a clinical diagnosis, HF independently increased stroke/ SE in 5 of 13 studies, conferring 1.6- to 3.1-fold increase in risk. When HF was defined as impaired left ventricular (LV) function on echocardiography, the additive risk was evident in 4 of 6 studies, with 1.7- to 2.6-fold increase in the risk of stroke/SE. The data about HF with preserved ejection fraction were less robust, although a recent presentation with acute decompensated HF increased the risk of stroke/SE, irrespective of ejection fraction. Implications: LV systolic impairment as identified by echocardiography is an independent risk factor for stroke/SE, although the magnitude by which it increases the risk of stroke cannot be precisely quantified. Whether a clinical diagnosis of HF is a significant risk factor remains inconclusive, although when the diagnosis is certain (recent decompensation requiring hospitalization), t does seem to be a significant risk factor irrespective of LV systolic function. [ABSTRACT FROM AUTHOR]
- Published
- 2014
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