Risk of stroke in chronic heart failure patients with preserved ejection fraction, but without atrial fibrillation: analysis of the CHARM-Preserved and I-Preserve trials Academic Article uri icon

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abstract

  • Aims: The incidence and predictors of stroke in patients with heart failure and preserved ejection fraction (HF-PEF), but without atrial fibrillation (AF), are unknown. We described the incidence of stroke in HF-PEF patients with and without AF and predictors of stroke in those without AF. Methods and results: We pooled data from the CHARM-Preserved and I-Preserve trials. Using Cox regression, we derived a model for stroke in patients without AF in this cohort and compared its performance with a published model in heart failure patients with reduced ejection fraction (HF-REF)-predictive variables: age, body mass index, New York Heart Association class, history of stroke, and insulin-treated diabetes. The two stroke models were compared and Kaplan-Meier curves for stroke estimated. The risk model was validated in a third HF-PEF trial. Of the 6701 patients, 4676 did not have AF. Stroke occurred in 124 (6.1%) with AF and in 171 (3.7%) without AF (rates 1.80 and 1.00 per 100 patient-years, respectively). There was no difference in performance of the stroke model derived in the HF-PEF cohort and the published HF-REF model (c-index 0.71, 95% confidence interval 0.57-0.84 vs. 0.73, 0.59-0.85, respectively) as the predictive variables overlapped. The model performed well in the validation cohort (0.86, 0.62-0.99). The rate of stroke in patients in the upper third of risk approximated to that in patients with AF (1.60 and 1.80 per 100 patient-years, respectively). Conclusions: A small number of clinical variables identify a subset of patients with HF-PEF, but without AF, at elevated risk of stroke.

authors

  • Abdul-Rahim, Azmil H
  • Perez, Ana-Cristina
  • MacIsaac, Rachael L
  • Jhund, Pardeep S
  • Claggett, Brian L
  • Carson, Peter E
  • Komajda, Michel
  • McKelvie, Robert
  • Zile, Michael R
  • Swedberg, Karl
  • Yusuf, Salim
  • Pfeffer, Marc A
  • Solomon, Scott D
  • Lip, Gregory YH
  • Lees, Kennedy R
  • McMurray, John JV

publication date

  • March 7, 2017